Provider Demographics
NPI:1285330829
Name:MILES, CHARLES PHILLIP
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:PHILLIP
Last Name:MILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PHILLIP
Other - Middle Name:
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2214 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-2109
Mailing Address - Country:US
Mailing Address - Phone:580-234-3791
Mailing Address - Fax:
Practice Address - Street 1:702 N GRAND ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3221
Practice Address - Country:US
Practice Address - Phone:580-234-3791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist