Provider Demographics
NPI:1891757654
Name:DAY, MILES RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:RUSSELL
Last Name:DAY
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 1:2804 N LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79415-1410
Mailing Address - Country:US
Mailing Address - Phone:806-744-7223
Mailing Address - Fax:806-740-3325
Practice Address - Street 1:4515 MARSHA SHARP FWY
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2520
Practice Address - Country:US
Practice Address - Phone:806-744-7223
Practice Address - Fax:806-740-3325
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6400207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111392100OtherFIRSTCARE COMMERCIAL
NM202011568Medicaid
NMX2475Medicaid
OK100153300AMedicaid
TX82687ZOtherHMO BLUE
TX132763702Medicaid
TX132763703Medicaid
NM202011568OtherPRESBYETERIAN COMMERCIAL
TX111392101Medicaid
TX87171GOtherBC BS
NM202011568OtherPRESBYETERIAN COMMERCIAL
NM202011568Medicaid
TX132763703Medicaid