Healthcare Provider Details

I. General information

NPI: 1043502016
Provider Name (Legal Business Name): MYLES GOLDFLIES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8212 DEVON CT
MYRTLE BEACH SC
29572-4178
US

IV. Provider business mailing address

8212 DEVON CT
MYRTLE BEACH SC
29572-4178
US

V. Phone/Fax

Practice location:
  • Phone: 843-839-5995
  • Fax: 843-839-1251
Mailing address:
  • Phone: 843-839-5995
  • Fax: 843-839-1251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number32417
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: