Provider Demographics
NPI:1174834659
Name:JEFFERSON T. MILEY, M.D.,P.A.
Entity Type:Organization
Organization Name:JEFFERSON T. MILEY, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:THAYER
Authorized Official - Last Name:MILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-617-6767
Mailing Address - Street 1:12180 N MOPAC EXPY
Mailing Address - Street 2:STE B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2909
Mailing Address - Country:US
Mailing Address - Phone:512-617-6767
Mailing Address - Fax:512-617-5598
Practice Address - Street 1:12180 N MOPAC EXPY
Practice Address - Street 2:STE B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2909
Practice Address - Country:US
Practice Address - Phone:512-617-6767
Practice Address - Fax:512-617-5598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1033292084N0400X
TXN58702084V0102X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty