Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 15324 | AZ |
NPI | 1164481156 |
---|---|
Provider Name | Marlin D. Mills |
First Address | Mesa, AZ 85210-6008 |
Second Address | Mesa, AZ 85210-6008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 29/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
249129 | (05) | AZ |
A27805 | (02) | AZ |
U3709 | (05) | NM |