Provider Demographics
NPI:1396911988
Name:BRIAN G MILLS, DPM INC
Entity type:Organization
Organization Name:BRIAN G MILLS, DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:951-658-2256
Mailing Address - Street 1:975 ST JOHN PLACE
Mailing Address - Street 2:STE B
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543
Mailing Address - Country:US
Mailing Address - Phone:951-658-2256
Mailing Address - Fax:
Practice Address - Street 1:975 SAINT JOHN PL
Practice Address - Street 2:STE B
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4428
Practice Address - Country:US
Practice Address - Phone:951-658-2256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4315213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E43150OtherLICENSE
CA000E43150Medicaid
U63121OtherUPIN
U63121OtherUPIN