Healthcare Provider Details

I. General information

NPI: 1376764282
Provider Name (Legal Business Name): JOAN D MILES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODIE MILES M.D.

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5171 S. COTTONWOOD ST, STE 610 BUILDING 1, SUITE 610
MURRAY UT
84107-8410
US

IV. Provider business mailing address

5121 S COTTONWOOD ST
MURRAY UT
84107-5701
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-3630
  • Fax: 801-507-3898
Mailing address:
  • Phone: 801-507-3630
  • Fax: 801-507-3898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number9005425-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number9005425-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: