Provider Demographics
NPI:1396158440
Name:CHILES, PAUL ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALLEN
Last Name:CHILES
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 1:5 KAMHOLZ RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98613
Mailing Address - Country:US
Mailing Address - Phone:509-773-7173
Mailing Address - Fax:
Practice Address - Street 1:5 KAMHOLZ RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:WA
Practice Address - Zip Code:98613
Practice Address - Country:US
Practice Address - Phone:509-773-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine