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General NPI Number Information
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NPI Number | 1134191034
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Entity Type | Individual
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Provider Name | BEVERLY DENISE MCMILLIN MD
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Gender | Female
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 02/08/2010
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Provider Practice Location Address
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Address Line | 10475 CENTURION PKWY N SUITE 302
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City | JACKSONVILLE
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State | FL
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Zip | 32256-5003
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Country | US
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Telephone | 904-398-5437
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Fax | 904-398-3077
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Provider Business Mailing Address
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Address Line | 1033 DR MARTIN LUTHER KING JR ST N STE. 108
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City | ST PETERSBURG
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State | FL
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Zip | 33701-1547
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Country | US
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Telephone | 727-456-4250
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Fax | 727-346-1044
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | ME36762
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | ME36762
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License Number State | FL
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