Basic Information
| Provider Information | |||||||||
| NPI: | 1275628349 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLS | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 N KENTUCKY AVE | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657752022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172562111 | ||||||||
| FaxNumber: | 4172564858 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 N KENTUCKY AVE | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657752022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172562111 | ||||||||
| FaxNumber: | 4172564858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 04/29/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2006038821 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2006038821 | 01 | MO | MISSOURI LICENSE | OTHER | 25-27144 | 01 | SC | STATE LICENSE NUMBER | OTHER | 200669406 | 05 | MO | MEDICAID | BM7400031 | 01 | DEA | OTHER |