Provider Demographics
NPI:1013028588
Name:MILES, DONALD A (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:A
Last Name:MILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1062650OtherFIRST HEALTH
CA3634414OtherCIGNA
CAG62396OtherBLUE CROSS
CA1092255OtherGREAT WEST
CA90026130OtherPACIFICARE
CA000810343419OtherPHCS
CA13076OtherINTERPLAN
CA865496OtherUNITED HEALTHCARE
CAMCMG170100OtherWESTERN HEALTH ADVANTAGE
CA011483OtherHEALTH NET
CA4509161OtherAETNA
CAMCMG170100OtherWESTERN HEALTH ADVANTAGE
CA1092255OtherGREAT WEST