Provider Demographics
NPI:1790084598
Name:MILES, GEORGE EMMETT JR (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EMMETT
Last Name:MILES
Suffix:JR
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LYRELEAF PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1542
Mailing Address - Country:US
Mailing Address - Phone:979-220-0663
Mailing Address - Fax:
Practice Address - Street 1:18 LYRELEAF PL
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-1542
Practice Address - Country:US
Practice Address - Phone:979-220-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241506208D00000X
TXQ6660207ZP0101X
MO2014011291207ZP0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology