Healthcare Provider Details

I. General information

NPI: 1366854408
Provider Name (Legal Business Name): DAVID MILLS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 YELLOWSTONE AVE
CODY WY
82414-9313
US

IV. Provider business mailing address

PO BOX 35100
BILLINGS MT
59107-5100
US

V. Phone/Fax

Practice location:
  • Phone: 307-527-7561
  • Fax:
Mailing address:
  • Phone: 307-527-7561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9495049-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11130A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: