Provider Demographics
NPI:1043502016
Name:GOLDFLIES, MYLES
Entity Type:Individual
Prefix:
First Name:MYLES
Middle Name:
Last Name:GOLDFLIES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8212 DEVON CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4178
Mailing Address - Country:US
Mailing Address - Phone:843-839-5995
Mailing Address - Fax:843-839-1251
Practice Address - Street 1:8212 DEVON CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4178
Practice Address - Country:US
Practice Address - Phone:843-839-5995
Practice Address - Fax:843-839-1251
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32417208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery