Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | DO686 | NV |
NPI | 1598762759 |
---|---|
Provider Name | Miles B Fine |
First Address | Las Vegas, NV 89146-9066 |
Second Address | Las Vegas, NV 89146-9066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F71723 | (02) | NV |