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Organization

LAVONNE R. MILLS, MD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LAVONNE R. MILLS MD (OWNER/PRESIDENT)
(208) 236-1600
Entity
Organization

Contact information

Practice address
3307 N STEPHANIE RD, POCATELLO, ID 83204-7285
(208) 705-5116
Mailing address
PO BOX 4699, POCATELLO, ID 83205-4699
(208) 236-1600

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M4489
ID

Other

Enumeration date
06/19/2008
Last updated
06/19/2008
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