Provider Demographics
NPI:1376764282
Name:MILES, JOAN D (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:D
Last Name:MILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5121 S COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5701
Mailing Address - Country:US
Mailing Address - Phone:801-507-3630
Mailing Address - Fax:801-507-3898
Practice Address - Street 1:5171 S. COTTONWOOD ST, STE 610
Practice Address - Street 2:BUILDING 1, SUITE 610
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8410
Practice Address - Country:US
Practice Address - Phone:801-507-3630
Practice Address - Fax:801-507-3898
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9005425-1205207X00000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1376764282Medicaid
WA0294913OtherL&I
WA8909598Medicare PIN