Provider Demographics
NPI:1871647990
Name:MILES, ROBERT ROY (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ROY
Last Name:MILES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S BELCHER RD
Mailing Address - Street 2:SUITE124
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3938
Mailing Address - Country:US
Mailing Address - Phone:727-443-4357
Mailing Address - Fax:727-443-4379
Practice Address - Street 1:50 S BELCHER RD
Practice Address - Street 2:SUITE 124
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3938
Practice Address - Country:US
Practice Address - Phone:727-443-4357
Practice Address - Fax:727-443-4379
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063213900Medicaid
FL2025562OtherINSURANCE ID
FL202564OtherINSURANCE ID
FL593623361OtherTAX ID
FL104667OtherINSURANCE ID
FL593623361OtherTAX ID
FL80359Medicare ID - Type Unspecified