Provider Demographics
NPI:1841229333
Name:NELSON, MILES V (MD)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:V
Last Name:NELSON
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 1:333 N BYRON BUTLER PKWY
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-2300
Mailing Address - Country:US
Mailing Address - Phone:850-584-8404
Mailing Address - Fax:850-584-3885
Practice Address - Street 1:333 N BYRON BUTLER PKWY
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2300
Practice Address - Country:US
Practice Address - Phone:850-584-8404
Practice Address - Fax:850-584-3885
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55617208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061431900Medicaid
FL09189OtherBCBS FL
FLE67465Medicare UPIN
FL061431900Medicaid