Healthcare Provider Details

I. General information

NPI: 1831189307
Provider Name (Legal Business Name): ERIC R MCMILLAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1069 E HAWKEYE AVE STE C
TURLOCK CA
95380-2618
US

IV. Provider business mailing address

PO BOX 1123
TURLOCK CA
95381-1123
US

V. Phone/Fax

Practice location:
  • Phone: 209-272-7442
  • Fax: 209-272-7443
Mailing address:
  • Phone: 209-272-7442
  • Fax: 209-272-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberG84397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: