Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 6639A | WY |
N | 207RX0202X | Medical Oncology | CP206749 | OR |
NPI | 1053400598 |
---|---|
Provider Name | Keith R Mills |
First Address | New Harbor, ME 04554 |
Second Address | New Harbor, ME 04554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 07/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
116613100 | (05) | WY |
B35055 | (02) |