Provider Demographics
NPI:1285629725
Name:MILNER, LARRY KENNETH (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:KENNETH
Last Name:MILNER
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6243 FAIRMONT PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-4045
Mailing Address - Country:US
Mailing Address - Phone:281-991-6400
Mailing Address - Fax:281-991-6405
Practice Address - Street 1:6243 FAIRMONT PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4045
Practice Address - Country:US
Practice Address - Phone:281-991-6400
Practice Address - Fax:281-991-6405
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9572207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1506123-01Medicare ID - Type Unspecified
TXB24911Medicare UPIN
TXB541B1Medicare ID - Type Unspecified