Healthcare Provider Details

I. General information

NPI: 1902895832
Provider Name (Legal Business Name): JOHN LOUIS MILLNS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 MEMORIAL HWY
TAMPA FL
33615-4531
US

IV. Provider business mailing address

6001 MEMORIAL HWY
TAMPA FL
33615-4531
US

V. Phone/Fax

Practice location:
  • Phone: 813-884-1626
  • Fax: 813-886-0589
Mailing address:
  • Phone: 813-884-1626
  • Fax: 813-886-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberME34694
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number35.037604
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberME34694
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: