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Individual
JAKE MCMILLON
Active
Individual
JAKE MCMILLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-11120
AR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213955795
—
AR
Enumeration date
03/22/2016
Last updated
06/17/2019
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