Provider Demographics
NPI:1801196779
Name:THOMAS PAUL MILES MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:THOMAS PAUL MILES MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-473-2840
Mailing Address - Street 1:1310 PRENTICE DR STE G
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-5005
Mailing Address - Country:US
Mailing Address - Phone:707-473-2840
Mailing Address - Fax:707-433-6184
Practice Address - Street 1:1310 PRENTICE DR STE G
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-5005
Practice Address - Country:US
Practice Address - Phone:707-473-2840
Practice Address - Fax:707-433-6184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG217290261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41362Medicare UPIN