Provider Demographics
NPI:1790738425
Name:MILLS, JOHN FREDERICK (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK
Last Name:MILLS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1800 GLENSIDE DR
Mailing Address - Street 2:#105
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3769
Mailing Address - Country:US
Mailing Address - Phone:804-288-1800
Mailing Address - Fax:804-288-0515
Practice Address - Street 1:1800 GLENSIDE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3769
Practice Address - Country:US
Practice Address - Phone:804-288-1800
Practice Address - Fax:804-288-0515
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102037144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5620694Medicaid
VAMC10635Medicare PIN
VA080003464Medicare ID - Type Unspecified