Provider Demographics
NPI:1295727568
Name:MYLES, CLIFFORD M (MD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:M
Last Name:MYLES
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:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37349-0299
Mailing Address - Country:US
Mailing Address - Phone:931-728-5607
Mailing Address - Fax:931-728-8354
Practice Address - Street 1:725 S JAMES CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-5962
Practice Address - Country:US
Practice Address - Phone:931-381-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30260207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3821161Medicaid
TN3079171OtherB/S OF TN
TN6539526003OtherCIGNA PLAN 110
TN1032043OtherAETNA HMO
TN2040326OtherUHC
TN347672OtherHEALTH 123
TN5252368OtherAETNA PPO
TN6539526004OtherCIGNA PLAN 139
TNF25563Medicare UPIN
TN2040326OtherUHC