MEDICARE: ERIC R 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
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	G84397	CA

General Provider Information

NPI Number	:	1831189307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC R MCMILLAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1123
Second Line	:
City	:	TURLOCK
State	:	CA
Zip	:	95381-1123
Country	:	US
Telephone Number	:	209-272-7442
Fax Number	:	209-272-7443

Provider Business Practice Location Address
First Line	:	1069 E HAWKEYE AVE STE C
Second Line	:
City	:	TURLOCK
State	:	CA
Zip	:	95380-2618
Country	:	US
Telephone Number	:	209-272-7442
Fax Number	:	209-272-7443

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	11/28/2018

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