Provider Demographics
NPI:1588694038
Name:MCMILLAN, JOHN M (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:949 CALHOUN PL
Mailing Address - Street 2:SUITE D
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4403
Mailing Address - Country:US
Mailing Address - Phone:951-652-8000
Mailing Address - Fax:951-929-6431
Practice Address - Street 1:949 CALHOUN PL
Practice Address - Street 2:SUITE D
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4403
Practice Address - Country:US
Practice Address - Phone:951-652-8000
Practice Address - Fax:951-929-6431
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA12166363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA121660Medicaid
CA0PA121660Medicare ID - Type Unspecified
CAR23416Medicare UPIN