Provider Demographics
NPI:1902008899
Name:MILES, JEFFREY DOUGLAS (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DOUGLAS
Last Name:MILES
Suffix:
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 1:1340 HAL GREER BLVD
Mailing Address - Street 2:NEUROPHYSIOLOGY DEPT.
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3800
Mailing Address - Country:US
Mailing Address - Phone:304-526-2000
Mailing Address - Fax:304-526-6326
Practice Address - Street 1:1340 HAL GREER BLVD
Practice Address - Street 2:ATTN: TAMMIE SILVA
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3800
Practice Address - Country:US
Practice Address - Phone:304-526-6387
Practice Address - Fax:304-526-6327
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0884292084N0400X
WV236922084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV002673403OtherHIGHMARK
WV3810015398Medicaid
WVWV0690AOtherMEDICARE PTAN CHHI HOSPITAL BASED
OH2979675Medicaid
WVWV0690BOtherMEDICARE PTAN CHHI CLINICS