Provider Demographics
NPI:1831189307
Name:MCMILLAN, ERIC R (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:R
Last Name:MCMILLAN
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:PO BOX 1123
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95381-1123
Mailing Address - Country:US
Mailing Address - Phone:209-272-7442
Mailing Address - Fax:209-272-7443
Practice Address - Street 1:1069 E HAWKEYE AVE STE C
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-2618
Practice Address - Country:US
Practice Address - Phone:209-272-7442
Practice Address - Fax:209-272-7443
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84397207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G843970Medicaid
CAF75013Medicare UPIN
CA00G843971Medicare ID - Type Unspecified