Provider Demographics
NPI:1063610376
Name:MILHOLLAND, REBECCA BLISS RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:BLISS RYAN
Last Name:MILHOLLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:BLISS
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 E BOULDER ST STE 700
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5533
Mailing Address - Country:US
Mailing Address - Phone:193-657-3007
Mailing Address - Fax:
Practice Address - Street 1:6451 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1402
Practice Address - Country:US
Practice Address - Phone:800-586-5022
Practice Address - Fax:866-588-2823
Is Sole Proprietor?:No
Enumeration Date:2007-07-07
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS79192084N0400X
CODR.00633682084N0400X
AZ468862084N0400X
IN10003376A2084N0400X
KS04-416212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ748419Medicaid
AZ748419Medicaid