Provider Demographics
NPI:1073512125
Name:MILES, SCOTT THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:THOMAS
Last Name:MILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:705 WELLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2982
Mailing Address - Country:US
Mailing Address - Phone:904-288-8311
Mailing Address - Fax:904-288-8371
Practice Address - Street 1:8262 POINT MEADOWS DR STE 201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4702
Practice Address - Country:US
Practice Address - Phone:904-288-8311
Practice Address - Fax:904-288-8371
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA743082083A0300X, 207QA0401X
IN01034481A2083A0300X, 207QA0401X
FLME125620207QA0401X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND16136Medicare UPIN
IN277210Medicare ID - Type Unspecified