Provider Demographics
NPI:1942275482
Name:VALLES, MIRIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:VALLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-3555
Mailing Address - Country:US
Mailing Address - Phone:334-756-6959
Mailing Address - Fax:334-756-7500
Practice Address - Street 1:5212 20TH AVE
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3555
Practice Address - Country:US
Practice Address - Phone:334-756-6959
Practice Address - Fax:334-756-7500
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009985055Medicaid
AL009985055Medicaid
AL000051856Medicare ID - Type Unspecified