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Individual

MILTON BIRD MCCOLL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
455 OCONNOR DR STE 200, SAN JOSE, CA 95128-1632
(408) 283-7676
Mailing address
4751 N 15TH ST, PHOENIX, AZ 85014-3707
(602) 277-7526

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
62712
AZ
208D00000X
General Practice Physician
Primary
GFE68043
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
62712
FAMILY MEDICINE
AZ
01
G68043
CA PHYSICIAN AND SURGEON LICENSE
CA
Enumeration date
02/08/2014
Last updated
04/30/2021
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