Healthcare Provider Details

I. General information

NPI: 1548304934
Provider Name (Legal Business Name): JOHN EMMET MILES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 GOTT RD
ENID OK
73705-5103
US

IV. Provider business mailing address

527 GOTT RD
ENID OK
73705-5103
US

V. Phone/Fax

Practice location:
  • Phone: 580-213-6763
  • Fax:
Mailing address:
  • Phone: 580-213-6763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number2007020559
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: