Healthcare Provider Details

I. General information

NPI: 1164685962
Provider Name (Legal Business Name): ROBERT ELWIN MILTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 S OREGON ST
YREKA CA
96097-3425
US

IV. Provider business mailing address

1924 BECHELLI LN
REDDING CA
96002-0128
US

V. Phone/Fax

Practice location:
  • Phone: 530-842-9200
  • Fax: 530-842-9207
Mailing address:
  • Phone: 775-813-4337
  • Fax: 775-359-5270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA19222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: