Provider Demographics
NPI:1326066457
Name:MILBURN, JOSEPH LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LESLIE
Last Name:MILBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2021 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 515
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2219
Mailing Address - Country:US
Mailing Address - Phone:972-259-3282
Mailing Address - Fax:972-259-2033
Practice Address - Street 1:2021 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 515
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2222
Practice Address - Country:US
Practice Address - Phone:972-259-3282
Practice Address - Fax:972-259-2033
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8923207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86Y592OtherBCBS
TX116886601Medicaid
TX116886601Medicaid
TX460001613Medicare PIN
F19196Medicare UPIN