Basic Information
| Provider Information | |||||||||
| NPI: | 1255569968 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLARD | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3801 5TH ST SE STE 110 | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983742106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538459585 | ||||||||
| FaxNumber: | 2538481126 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 5TH ST SE STE 110 | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983742106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538459585 | ||||||||
| FaxNumber: | 2538481126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2009 | ||||||||
| LastUpdateDate: | 06/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | A135513 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XS0117X | MD61265817 | WA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207X00000X | MD61265817 | WA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.