Healthcare Provider Details

I. General information

NPI: 1992753487
Provider Name (Legal Business Name): TERRY H MCMILLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 COMMERCE DR
LAS CRUCES NM
88011-8209
US

IV. Provider business mailing address

1130 COMMERCE DR
LAS CRUCES NM
88011-8209
US

V. Phone/Fax

Practice location:
  • Phone: 505-521-3025
  • Fax:
Mailing address:
  • Phone: 505-521-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number93-330
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: