Provider Demographics
NPI:1295744571
Name:MCMILLAN-GORDON, BRIM AARON (DPM)
Entity type:Individual
Prefix:DR
First Name:BRIM
Middle Name:AARON
Last Name:MCMILLAN-GORDON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 LA CASA VIA
Mailing Address - Street 2:STE #110
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3091
Mailing Address - Country:US
Mailing Address - Phone:925-935-8255
Mailing Address - Fax:925-935-8258
Practice Address - Street 1:112 LA CASA VIA
Practice Address - Street 2:STE #110
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3091
Practice Address - Country:US
Practice Address - Phone:925-935-8255
Practice Address - Fax:925-935-8258
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA36771Medicare UPIN
CA000E36771Medicare ID - Type Unspecified