MEDICARE: DR. MARK W MILLARD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	G0775	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609877737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK W MILLARD M.D.

Provider Business Mailing Address
First Line	:	3600 GASTON AVE
Second Line	:	LB-143
City	:	DALLAS
State	:	TX
Zip	:	75246
Country	:	US
Telephone Number	:	214-827-0067
Fax Number	:	214-827-8840

Provider Business Practice Location Address
First Line	:	4004 WORTH ST
Second Line	:	SUITE 300
City	:	DALLAS
State	:	TX
Zip	:	75246
Country	:	US
Telephone Number	:	214-820-3500
Fax Number	:	214-820-9799

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/05/2023

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