Provider Demographics
NPI:1184345860
Name:DOUGLAS, MYLES (MD)
Entity type:Individual
Prefix:
First Name:MYLES
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:401 E JACKSON ST STE 2340
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5226
Mailing Address - Country:US
Mailing Address - Phone:813-683-5044
Mailing Address - Fax:855-861-0819
Practice Address - Street 1:4700 N HABANA AVE STE 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7117
Practice Address - Country:US
Practice Address - Phone:813-513-3030
Practice Address - Fax:885-861-0819
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2024-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME206072086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery