Provider Demographics
NPI:1407915226
Name:MILLS, DAVID JOHN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
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 1:2830 PUESTA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3006
Mailing Address - Country:US
Mailing Address - Phone:805-682-9666
Mailing Address - Fax:
Practice Address - Street 1:2830 PUESTA DEL SOL
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105
Practice Address - Country:US
Practice Address - Phone:805-682-9666
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG778892085R0203X
MN502962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1407915226OtherAMERICA'S PPO
MN134996OtherUCARE
MN1407915226OtherMEDICA
MN960371052306OtherPREFERRED ONE
MN03083COOtherBLUE CROSS AND BLUE SHIELD OF MN
MN612627100Medicaid
WI34954100Medicaid
MNHP79266OtherHEALTHPARTNERS
MNP00473006OtherRR MEDICARE
IA1407915226Medicaid
MN254738OtherMIDLANDS CHOICE INC
IA1407915226Medicaid
MN1407915226OtherAMERICA'S PPO
MN254738OtherMIDLANDS CHOICE INC
F92629Medicare UPIN
WI34954100Medicaid
MN300004340Medicare PIN