Healthcare Provider Details

I. General information

NPI: 1477542223
Provider Name (Legal Business Name): DAVID ADDISON MILES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 05/21/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HENLEY LN
BAKER FL
32531-2702
US

IV. Provider business mailing address

PO BOX 17567
PENSACOLA FL
32522-7567
US

V. Phone/Fax

Practice location:
  • Phone: 850-969-7979
  • Fax: 850-476-9352
Mailing address:
  • Phone: 850-969-7979
  • Fax: 850-476-9352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME36788
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: