Provider Demographics
NPI:1699885160
Name:MILLARD, JOHN B (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:MILLARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5030 CAMINO DE LA SIESTA
Mailing Address - Street 2:STE 208
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3117
Mailing Address - Country:US
Mailing Address - Phone:619-260-6300
Mailing Address - Fax:619-260-6313
Practice Address - Street 1:5030 CAMINO DE LA SIESTA
Practice Address - Street 2:STE 208
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3117
Practice Address - Country:US
Practice Address - Phone:619-260-6300
Practice Address - Fax:619-260-6313
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG34697207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G346970Medicaid
CAG34697Medicare ID - Type Unspecified
CA00G346970Medicaid