Individual
DR. MATTHEW PAUL MILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-6175
(601) 200-2020
Mailing address
PO BOX 23457, JACKSON, MS 39225-3457
(601) 200-6175
(601) 200-2020
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
18834
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1142158
—
LA
01
—
512G70003
MS MEDICARE - GROUP
MS
Enumeration date
07/25/2006
Last updated
06/05/2020
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