Provider Demographics
NPI:1568483907
Name:MYLES, WAYNE J (DO)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:J
Last Name:MYLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:510 CHERRY STREET
Mailing Address - Street 2:BUILDING A, SUITE 308
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701
Mailing Address - Country:US
Mailing Address - Phone:304-325-1905
Mailing Address - Fax:304-323-6011
Practice Address - Street 1:3851 N RIVER RD
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-3762
Practice Address - Country:US
Practice Address - Phone:317-988-1772
Practice Address - Fax:317-988-5631
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV1717207Q00000X
OH34006715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2039654Medicaid
OHP00787559OtherRAILROAD MEDICARE
OH292801OtherOHIO MEDICAID UNISON
WV5630064000Medicaid
OH310917085219OtherOHIO MEDICAID CARESOURCE
OH2039654OtherOHIO MEDICAID MOLINA
OH2039654OtherOHIO MEDICAID MOLINA
WV5630064000Medicaid
OH2039654Medicaid
OH000000634471OtherANTHEM
OHMY0843715Medicare ID - Type Unspecified