Healthcare Provider Details

I. General information

NPI: 1285700450
Provider Name (Legal Business Name): JOHN A MILLARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 INVERNESS DR W STE 200
ENGLEWOOD CO
80112-5211
US

IV. Provider business mailing address

195 INVERNESS DR W STE 200
ENGLEWOOD CO
80112-5211
US

V. Phone/Fax

Practice location:
  • Phone: 303-792-5665
  • Fax: 303-858-0495
Mailing address:
  • Phone: 303-792-5665
  • Fax: 303-858-0495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number30541
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: