Individual
JAMES C MACMILLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1541 FLORIDA AVE, 103, MODESTO, CA 95350-4423
(209) 577-3388
(209) 523-0764
Mailing address
1541 FLORIDA AVE, 200, MODESTO, CA 95350-4423
(209) 577-3388
(209) 523-0764
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
G23487
CA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
G23487
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CD069A
MEDICARE GROUP PTAN
CA
05
—
ZZZ76734Z
—
CA
Enumeration date
05/31/2006
Last updated
07/13/2011
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