Provider Demographics
NPI:1831109156
Name:MCMILLAN, JANE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ELIZABETH
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5205
Mailing Address - Country:US
Mailing Address - Phone:575-624-4646
Mailing Address - Fax:575-625-8498
Practice Address - Street 1:350 W COUNTRY CLUB RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5205
Practice Address - Country:US
Practice Address - Phone:575-624-4646
Practice Address - Fax:575-625-8498
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233325207V00000X
NMMD2011-0411207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM09856323Medicaid
VA6216544Medicaid
VAC06165Medicare PIN
VAH62451Medicare UPIN
VA6216544Medicaid