Provider Demographics
NPI:1467451435
Name:MILLS, ROBERT CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
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:PO BOX 680949
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-1610
Mailing Address - Country:US
Mailing Address - Phone:256-997-2189
Mailing Address - Fax:256-638-7445
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968
Practice Address - Country:US
Practice Address - Phone:256-845-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC286722085R0202X
AL279802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-39513OtherBC BS OF AL
AL009941512Medicaid
AL009941512Medicaid
NC213438AMedicare ID - Type Unspecified
NCC87055Medicare UPIN