Basic Information
| Provider Information | |||||||||
| NPI: | 1477542223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILES | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ADDISON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17567 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325227567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509697979 | ||||||||
| FaxNumber: | 8504769352 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 HENLEY LN | ||||||||
| Address2: | |||||||||
| City: | BAKER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325312702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509697979 | ||||||||
| FaxNumber: | 8504769352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2005 | ||||||||
| LastUpdateDate: | 05/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | ME36788 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 17475 | 01 | FL | BCBS OF FL | OTHER | 5638025 | 01 | AETNA | OTHER | 59166821MIL | 01 | AL | BCBS OF ALABAMA | OTHER | 065064100 | 05 | FL | MEDICAID | 4040398 | 01 | TN | BC OF TENNESSEE | OTHER | NQ362 | 01 | FL | MEDICARE OF FL | OTHER | Q00062537 | 01 | FL | RAILROAD MEDICARE OF FL | OTHER | 2500248 | 01 | UNITED HEALTHCARE | OTHER | 009962390 | 01 | AL | MEDICAID | OTHER |