MEDICARE: DR. FLOYD JACKSON MILLET 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	174400000X	Specialist	149545-1205	UT

General Provider Information

NPI Number	:	1508112426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FLOYD JACKSON MILLET MD

Provider Business Mailing Address
First Line	:	2015 SCENIC DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-3317
Country	:	US
Telephone Number	:	801-467-0288
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 SCENIC DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-3317
Country	:	US
Telephone Number	:	801-467-0288
Fax Number	:

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

Provider Enumeration Date	:	07/29/2012
Last Update Date	:	07/29/2012

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