Provider Demographics
NPI:1346419611
Name:D S MILES DPM PA
Entity Type:Organization
Organization Name:D S MILES DPM PA
Other - Org Name:DAWN MILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
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:904-808-9950
Mailing Address - Fax:
Practice Address - Street 1:220 SOUTHPARK CIR E
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5135
Practice Address - Country:US
Practice Address - Phone:904-808-9950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:D S MILES DPM PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-21
Last Update Date:2010-05-21
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
FL65513AOtherBC/BS
FL390361301Medicaid
FL65513YMedicare PIN
FL65513AOtherBC/BS
FL390361301Medicaid
FL3924770001Medicare NSC