Healthcare Provider Details

I. General information

NPI: 1538788872
Provider Name (Legal Business Name): DAINON MILES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 BLUEBONNET BLVD STE 100
BATON ROUGE LA
70810-7827
US

IV. Provider business mailing address

40502 MARY ANN ST
PRAIRIEVILLE LA
70769-5427
US

V. Phone/Fax

Practice location:
  • Phone: 225-924-2424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number337926
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: