Provider Demographics
NPI:1306050109
Name:LILES, JOE SPENCER (MD)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:SPENCER
Last Name:LILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-660-5763
Mailing Address - Fax:251-660-5752
Practice Address - Street 1:1601 CENTER ST
Practice Address - Street 2:STE 2N
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1512
Practice Address - Country:US
Practice Address - Phone:251-660-5763
Practice Address - Fax:251-660-5752
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP58362086X0206X
AL278182086X0206X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX322529401 (MDACC)Medicaid
TX287940YKQH (MDACC)Medicare PIN