Provider Demographics
NPI:1093715252
Name:MILES, WILLIAM B (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:MILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1100 N BROAD ST
Mailing Address - Street 2:STE B
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-2700
Mailing Address - Country:US
Mailing Address - Phone:928-425-0322
Mailing Address - Fax:928-425-5620
Practice Address - Street 1:1100 N BROAD ST STE B
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-2700
Practice Address - Country:US
Practice Address - Phone:928-425-0322
Practice Address - Fax:928-425-5620
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37479207W00000X
NE23360207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47054533500Medicaid
AZ690869Medicaid
AZ117888Medicare PIN
NE47054533500Medicaid
NE278986Medicare ID - Type Unspecified