=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750651584
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAWRENCE JAY MILLS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2012
-----------------------------------------------------
Last Update Date | 01/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9154 STONE CREEK PL
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243-6217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-437-8360
-----------------------------------------------------
Fax | 970-923-6206
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9154 STONE CREEK PL
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243-6217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-437-8360
-----------------------------------------------------
Fax | 970-923-6206
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208G00000X
-----------------------------------------------------
Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
-----------------------------------------------------
License Number | AFE23515
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------