Individual
MR. JOHN BRENT MILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6555 COYLE AVENUE, CARMICHAEL, CA 95608
(916) 536-3670
(916) 536-2480
Mailing address
3400 DATA DR, PHYSICIAN SUPPORT SERVICES, RANCHO CORDOVA, CA 95670-7956
(916) 379-2948
(916) 858-7065
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA05080
TX
363A00000X
Physician Assistant
PA22162
CA
363AS0400X
Surgical Physician Assistant
PA05080
TX
363AS0400X
Surgical Physician Assistant
Primary
PA22162
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA05080
PA LICENSE
TX
01
—
PA22162
PHYSICIAN ASSISTANT LICENSE
CA
Enumeration date
03/08/2007
Last updated
02/11/2022
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