Provider Demographics
NPI:1669518130
Name:MILLS, TREVOR J (MD)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:J
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 1:39632 PRIMROSE PL
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-9758
Mailing Address - Country:US
Mailing Address - Phone:530-753-3453
Mailing Address - Fax:
Practice Address - Street 1:2021 PERDIDO ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1352
Practice Address - Country:US
Practice Address - Phone:504-903-3594
Practice Address - Fax:504-903-4569
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022317207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1669601Medicaid
LA4E000Medicare ID - Type Unspecified
LAG17213Medicare UPIN