Provider Demographics
NPI:1902847445
Name:MILLS, WESLEY C (MD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:C
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 1:8075 GATE PARKWAY WEST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3685
Mailing Address - Country:US
Mailing Address - Phone:904-400-6500
Mailing Address - Fax:904-400-6501
Practice Address - Street 1:8075 GATE PARKWAY WEST
Practice Address - Street 2:SUITE 202
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3685
Practice Address - Country:US
Practice Address - Phone:904-400-6500
Practice Address - Fax:904-400-6501
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83961207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME83961OtherMEDICAL LICENSE NUMBER
FLME83961OtherMEDICAL LICENSE NUMBER
FL71403VMedicare PIN
FLME83961OtherMEDICAL LICENSE NUMBER