Healthcare Provider Details

I. General information

NPI: 1407075302
Provider Name (Legal Business Name): J L MILES, DO SLEEP LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3418 MAIN ST
MOSS POINT MS
39563-5102
US

IV. Provider business mailing address

PO BOX 3590
VICTORIA TX
77903-3590
US

V. Phone/Fax

Practice location:
  • Phone: 228-474-6111
  • Fax: 361-576-4219
Mailing address:
  • Phone: 361-576-3680
  • Fax: 361-576-4219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number16488
License Number StateTX

VIII. Authorized Official

Name: DR. JANICE L MILES
Title or Position: OWNER
Credential: D.O.
Phone: 228-474-6111