Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO2627 | FL |
Y | 222Z00000X | Podiatrist | PO2627 | FL |
NPI | 1013972413 |
---|---|
Provider Name | Dr. Dawn Shepherd Miles |
First Address | East Palatka, FL 32131-0368 |
Second Address | Palatka, FL 32177 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 27/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
390361300 | (05) | FL |
U66741 | (02) |