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General NPI Number Information
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NPI Number | 1427032531
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Entity Type | Individual
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Provider Name | JON MICHAEL MCMILLAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 0310 COUNTY ROAD 14
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City | DEL NORTE
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State | CO
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Zip | 81132-8719
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Country | US
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Telephone | 719-657-2510
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Fax | 719-657-4106
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Provider Business Mailing Address
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Address Line | 0310 COUNTY ROAD 14
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City | DEL NORTE
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State | CO
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Zip | 81132-8719
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Country | US
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Telephone | 719-657-2510
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Fax | 719-657-4106
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 32259
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License Number State | CO
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