Provider Demographics
NPI:1780774752
Name:MILES, BRIAN J (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:MILES
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 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-441-8111
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-441-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5837208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CE330OtherBLUE CROSS BLUE SHIELD
TX124512802Medicaid
TXP01055710OtherRR MEDICARE
TX1780774752OtherBLUE CROSS BLUE SHIELD
TX8DY961OtherBLUE CROSS BLUE SHIELD
TX8F8177OtherMEDICARE PTAN
TX8CE330OtherBLUE CROSS BLUE SHIELD
TXP01055710OtherRR MEDICARE
TX8F8177OtherMEDICARE PTAN
TX8DY961OtherBLUE CROSS BLUE SHIELD
TXB46819Medicare UPIN
TX472540ZSWDMedicare PIN