Healthcare Provider Details

I. General information

NPI: 1104833227
Provider Name (Legal Business Name): RONALD G MILLS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 01/04/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MADISON PROFESSIONAL PARK
REXBURG ID
83440
US

IV. Provider business mailing address

10 MADISON PROFESSIONAL PARK
REXBURG ID
83440
US

V. Phone/Fax

Practice location:
  • Phone: 208-356-9666
  • Fax: 208-356-9663
Mailing address:
  • Phone: 208-356-9666
  • Fax: 208-356-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberM6255
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: