Healthcare Provider Details

I. General information

NPI: 1457512121
Provider Name (Legal Business Name): JONATHAN COMPTON MILLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 03/07/2023
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 SUMMIT BLVD UNIT 204
BROOMFIELD CO
80021-8253
US

IV. Provider business mailing address

403 SUMMIT BLVD UNIT 204
BROOMFIELD CO
80021-8253
US

V. Phone/Fax

Practice location:
  • Phone: 720-401-2139
  • Fax: 303-469-4439
Mailing address:
  • Phone: 720-401-2139
  • Fax: 303-469-4439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2008017177
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number51866
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: