Provider Demographics
NPI:1477542223
Name:MILES, DAVID ADDISON (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ADDISON
Last Name:MILES
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 17567
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32522-7567
Mailing Address - Country:US
Mailing Address - Phone:850-969-7979
Mailing Address - Fax:850-476-9352
Practice Address - Street 1:1200 HENLEY LN
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:FL
Practice Address - Zip Code:32531-2702
Practice Address - Country:US
Practice Address - Phone:850-969-7979
Practice Address - Fax:850-476-9352
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36788207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17475OtherBCBS OF FL
5638025OtherAETNA
AL59166821MILOtherBCBS OF ALABAMA
FL065064100Medicaid
TN4040398OtherBC OF TENNESSEE
FLNQ362OtherMEDICARE OF FL
FLQ00062537OtherRAILROAD MEDICARE OF FL
2500248OtherUNITED HEALTHCARE
AL009962390OtherMEDICAID
FL065064100Medicaid