MEDICARE: DR. BEVERLY DENISE MCMILLIN MD

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
1	207YP0228X	Pediatric Otolaryngology Physician	ME36762	FL
2	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	ME36762	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12056336	OTHER	FL	MULTI PLAN
2	208957	OTHER	FL	AVMED
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P2759499	OTHER	FL	OXFORD
5	0205114006	OTHER	FL	CIGNA
6	4234338	OTHER	FL	AETNA
7	53712	OTHER	FL	BC/BS OF FL
8	728	OTHER	FL	MAYO

General Provider Information

NPI Number	:	1134191034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEVERLY DENISE MCMILLIN MD

Provider Business Mailing Address
First Line	:	1033 DR MARTIN LUTHER KING JR ST N
Second Line	:	STE. 108
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-1547
Country	:	US
Telephone Number	:	727-456-4250
Fax Number	:	727-346-1044

Provider Business Practice Location Address
First Line	:	10475 CENTURION PKWY N
Second Line	:	SUITE 302
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-5003
Country	:	US
Telephone Number	:	904-398-5437
Fax Number	:	904-398-3077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	02/08/2010

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Directions to “ DR. BEVERLY DENISE MCMILLIN MD” Practice Location

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