Provider Demographics
NPI:1114164456
Name:D.S.MILES DPM, PA
Entity Type:Organization
Organization Name:D.S.MILES DPM, PA
Other - Org Name:DAWN S. MILES DPM PA
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:SHEPHERD
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:386-328-7228
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:EAST PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32131-0368
Mailing Address - Country:US
Mailing Address - Phone:386-328-7228
Mailing Address - Fax:386-328-3351
Practice Address - Street 1:220 SOUTHPARK CIR E
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5135
Practice Address - Country:US
Practice Address - Phone:904-808-9950
Practice Address - Fax:386-328-3351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2627213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3924770001Medicare PIN