Healthcare Provider Details

I. General information

NPI: 1679624449
Provider Name (Legal Business Name): JOHN ROBERT MILLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SULLIVAN AVE
DALY CITY CA
94015
US

IV. Provider business mailing address

705 NOE ST
SAN FRANCISCO CA
94114-2922
US

V. Phone/Fax

Practice location:
  • Phone: 650-315-7928
  • Fax:
Mailing address:
  • Phone: 650-315-7928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG76506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: