Provider Demographics
NPI:1255325908
Name:MILES, THOMAS P (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:MILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 PRENTICE DR
Mailing Address - Street 2:STE G
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3384
Mailing Address - Country:US
Mailing Address - Phone:707-473-2840
Mailing Address - Fax:707-433-6184
Practice Address - Street 1:1310 PRENTICE DR
Practice Address - Street 2:STE G
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3384
Practice Address - Country:US
Practice Address - Phone:707-473-2840
Practice Address - Fax:707-433-6184
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG21729174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41362Medicare UPIN