Provider Demographics
NPI:1295710598
Name:MILES, JANICE L (DO)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:MILES
Suffix:
Gender:F
Credentials:DO
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 3590
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-3590
Mailing Address - Country:US
Mailing Address - Phone:228-474-6111
Mailing Address - Fax:361-576-4219
Practice Address - Street 1:3418 MAIN ST
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39563-5102
Practice Address - Country:US
Practice Address - Phone:228-474-6111
Practice Address - Fax:361-576-4219
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSDO16488207RP1001X, 207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
640934949OtherTAX ID #
MS00121255Medicaid
MS290000074Medicare ID - Type UnspecifiedMISSISSIPPI MEDI #
MS00121255Medicaid