MEDICARE: JANICE L MILES DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	DO16488	MS
2	207R00000X	Internal Medicine Physician	DO16488	MS
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician	DO16488	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	640934949	OTHER		TAX ID #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295710598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE L MILES DO

Provider Business Mailing Address
First Line	:	PO BOX 3590
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77903-3590
Country	:	US
Telephone Number	:	228-474-6111
Fax Number	:	361-576-4219

Provider Business Practice Location Address
First Line	:	3418 MAIN ST
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39563-5102
Country	:	US
Telephone Number	:	228-474-6111
Fax Number	:	361-576-4219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	11/18/2010

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