Provider Demographics
NPI:1326094509
Name:MILLS, SCOTT D (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:MILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 SE 91ST AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-3756
Mailing Address - Country:US
Mailing Address - Phone:503-774-7700
Mailing Address - Fax:503-774-7701
Practice Address - Street 1:9200 SE 91ST AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-3756
Practice Address - Country:US
Practice Address - Phone:503-774-7700
Practice Address - Fax:503-774-7701
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD254182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269600Medicaid
MS00125133Medicaid
LA1990493Medicaid
LA5U473Medicare PIN
MS300000908Medicare PIN
LA1990493Medicaid
MS00125133Medicaid