Provider Demographics
NPI:1881752970
Name:MILES, LINDA M (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:MILES
Suffix:
Gender:F
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 210
Mailing Address - Street 2:318 ABALONE LOOP
Mailing Address - City:MESCALERO
Mailing Address - State:NM
Mailing Address - Zip Code:88340-0210
Mailing Address - Country:US
Mailing Address - Phone:505-464-4441
Mailing Address - Fax:505-464-3877
Practice Address - Street 1:318 ABALONE LOOP
Practice Address - Street 2:
Practice Address - City:MESCALERO
Practice Address - State:NM
Practice Address - Zip Code:88340-0210
Practice Address - Country:US
Practice Address - Phone:505-464-4441
Practice Address - Fax:505-464-3877
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601005208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH2347Medicaid
NMH2347Medicaid