Provider Demographics
NPI:1053483057
Name:RAYMOND A MILLETTE
Entity Type:Organization
Organization Name:RAYMOND A MILLETTE
Other - Org Name:MILLETTE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-471-9022
Mailing Address - Street 1:1014 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1420
Mailing Address - Country:US
Mailing Address - Phone:541-471-9022
Mailing Address - Fax:541-471-9055
Practice Address - Street 1:1014 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1420
Practice Address - Country:US
Practice Address - Phone:541-471-9022
Practice Address - Fax:541-471-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR95000636363LF0000X
OR200550153363LF0000X
OR200550156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR292050Medicaid
OR026845Medicaid
ORP00655554OtherRAILROAD MEDICARE
OR297670Medicaid
ORP00641991OtherRAILROAD MEDICARE
OR272449Medicaid
OR026845Medicaid
ORR131565Medicare PIN
OR292050Medicaid
ORP00655554OtherRAILROAD MEDICARE
ORS91813Medicare UPIN
ORR134158Medicare PIN
OR297670Medicaid
ORP00149810Medicare PIN