Healthcare Provider Details

I. General information

NPI: 1922292259
Provider Name (Legal Business Name): JEFFERSON THAYER MILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N INTERSTATE 35 STE 300
AUSTIN TX
78701-1926
US

IV. Provider business mailing address

1400 N INTERSTATE 35 STE 300
AUSTIN TX
78701-1926
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-8300
  • Fax: 512-324-8301
Mailing address:
  • Phone: 512-324-8300
  • Fax: 512-324-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberN5870
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberN5870
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberN5870
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: