Provider Demographics
NPI:1013972413
Name:MILES, DAWN SHEPHERD (DPM)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:SHEPHERD
Last Name:MILES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:EAST PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32131-0368
Mailing Address - Country:US
Mailing Address - Phone:386-328-7228
Mailing Address - Fax:386-328-3351
Practice Address - Street 1:205 ZEAGLER DR STE 201
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3860
Practice Address - Country:US
Practice Address - Phone:386-328-7228
Practice Address - Fax:386-328-3351
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2627213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390361300Medicaid
FL390361300Medicaid
FL65513Medicare PIN