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General NPI Number Information
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NPI Number | 1801061601
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Entity Type | Organization
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Legal Business Name | BRENDAN M. MILES
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 411B MAIN ST S
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City | AMORY
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State | MS
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Zip | 38821-4221
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Country | US
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Telephone | 662-256-5807
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Fax | 662-256-3729
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Provider Business Mailing Address
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Address Line | 411B MAIN ST S
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City | AMORY
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State | MS
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Zip | 38821-4221
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Country | US
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Telephone | 662-256-5807
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Fax | 662-256-3729
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Authorized Official
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Title or Position | RADIOLOGIST/OWNER
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Name | DR. BRENDAN MATHEW MILES
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Credential | M.D.
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Telephone | 662-256-5807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number | 08217
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License Number State | MS
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