Healthcare Provider Details

I. General information

NPI: 1205942059
Provider Name (Legal Business Name): CHRISTIAN SCOTT MILLWARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 S MEDICAL CENTER DR SUITE 120
ST GEORGE UT
84790-7017
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-4460
  • Fax:
Mailing address:
  • Phone: 435-628-4460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number5960240-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: