MEDICARE: DR. ROBERT CHARLES MILLS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	28672	NC
2	2085R0202X	Diagnostic Radiology Physician	27980	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	515-39513	OTHER	AL	BC BS OF AL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467451435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT CHARLES MILLS MD

Provider Business Mailing Address
First Line	:	PO BOX 680949
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-1610
Country	:	US
Telephone Number	:	256-997-2189
Fax Number	:	256-638-7445

Provider Business Practice Location Address
First Line	:	200 MEDICAL CENTER DR
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968
Country	:	US
Telephone Number	:	256-845-3150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/08/2007

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