Provider Demographics
NPI:1831198738
Name:MILES, DAVID RALPH (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RALPH
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 1:1717 SHIPYARD BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8019
Mailing Address - Country:US
Mailing Address - Phone:910-794-1717
Mailing Address - Fax:910-794-1552
Practice Address - Street 1:1717 SHIPYARD BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8019
Practice Address - Country:US
Practice Address - Phone:910-794-1717
Practice Address - Fax:910-794-1552
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-39036174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02819OtherBLUE BROSS BLUE SHIELD