Healthcare Provider Details

I. General information

NPI: 1558506378
Provider Name (Legal Business Name): NICHOLAS MILLS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3170 STATE ST
MEDFORD OR
97504-8450
US

IV. Provider business mailing address

3170 STATE ST
MEDFORD OR
97504-8450
US

V. Phone/Fax

Practice location:
  • Phone: 541-864-8900
  • Fax: 541-245-3315
Mailing address:
  • Phone: 541-864-8900
  • Fax: 541-245-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberAR2812750-RM-82
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: