Provider Demographics
NPI:1588614929
Name:MILES, STACIA C (MD)
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:C
Last Name:MILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-334-2401
Mailing Address - Fax:512-334-2491
Practice Address - Street 1:1250 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:BLDG 3 FL 1
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6446
Practice Address - Country:US
Practice Address - Phone:512-334-2401
Practice Address - Fax:512-334-2491
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3645207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183043201Medicaid
TXP00349853Medicare PIN
TX183043201Medicaid
TX8G9004Medicare PIN