Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2013020328 | MO |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 2013020328 | MO |
NPI | 1194164244 |
---|---|
Provider Name | Jeffrey Milles |
First Address | Columbia, MO 65201-7199 |
Second Address | Columbia, MO 65201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2013 |
Last Update Date | 29/09/2020 |