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NPI Code Detail

MEDICARE: DAMON C. MCMILLAN M.D.

MEDICARE:   DAMON C. MCMILLAN  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianME76689FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15399OTHERFLBC/BS OF FLORIDA
2209999OTHERFLHEALTHEASE FLORIDA #2
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5162001OTHERFLHEALTHEASE OF FLORIDA#1

General Provider Information

NPI Number : 1053384164
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAMON C. MCMILLAN M.D.
Provider Business Mailing Address
First Line : 1720 S GADSDEN ST
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32301-5506
Country : US
Telephone Number : 850-576-4073
Fax Number : 850-576-2824
Provider Business Practice Location Address
First Line : 1720 S GADSDEN ST
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32301-5506
Country : US
Telephone Number : 850-576-4073
Fax Number : 850-576-2824
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 10/15/2010

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Directions to “ DAMON C. MCMILLAN M.D.” Practice Location

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