MEDICARE: DR. FAY E. MILLETT 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	174400000X	Specialist	D5444	TX

General Provider Information

NPI Number	:	1740276740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAY E. MILLETT M.D.

Provider Business Mailing Address
First Line	:	1900 N OREGON ST
Second Line	:	SUITE 209
City	:	EL PASO
State	:	TX
Zip	:	79902-3351
Country	:	US
Telephone Number	:	915-532-3697
Fax Number	:	915-532-3506

Provider Business Practice Location Address
First Line	:	1900 N OREGON ST
Second Line	:	SUITE 209
City	:	EL PASO
State	:	TX
Zip	:	79902-3351
Country	:	US
Telephone Number	:	915-532-3697
Fax Number	:	915-532-3506

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

Provider Enumeration Date	:	09/25/2005
Last Update Date	:	07/08/2007

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