Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | E4315 | CA |
NPI | 1386647220 |
---|---|
Provider Name | Dr. Brian Glenn Mills SR. |
First Address | Hemet, CA 92543-4428 |
Second Address | Hemet, CA 92543-4428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 16/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E43150 | (05) | CA |
E4315 | LICENSE (01) | CA |
P00101130 | RAILROAD MEDICARE (01) | |
U63121 | (02) | CA |