Provider Demographics
NPI:1477358026
Name:GRICE, MILES T IV
Entity type:Individual
Prefix:MR
First Name:MILES
Middle Name:T
Last Name:GRICE
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2330
Mailing Address - Country:US
Mailing Address - Phone:850-252-9652
Mailing Address - Fax:
Practice Address - Street 1:597 W 11TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2330
Practice Address - Country:US
Practice Address - Phone:850-252-9652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator