Provider Demographics
NPI:1891015210
Name:MILLARD, DEVAN (MD)
Entity Type:Individual
Prefix:
First Name:DEVAN
Middle Name:
Last Name:MILLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEVAN
Other - Middle Name:NOELLE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5444 S WAYMAN LN
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7830
Mailing Address - Country:US
Mailing Address - Phone:801-688-0409
Mailing Address - Fax:801-506-0296
Practice Address - Street 1:500 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-1348
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0070835207Q00000X
UT8125293-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine