Provider Demographics
NPI:1417939505
Name:MILES, THOMAS EUGENE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EUGENE
Last Name:MILES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:301 W HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-3462
Mailing Address - Country:US
Mailing Address - Phone:626-445-1595
Mailing Address - Fax:626-445-6182
Practice Address - Street 1:301 W HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3462
Practice Address - Country:US
Practice Address - Phone:626-445-1595
Practice Address - Fax:626-445-6182
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG38599207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47530Medicare UPIN