Provider Demographics
NPI:1578564118
Name:MCMILLAN, CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3194
Mailing Address - Country:US
Mailing Address - Phone:817-321-0404
Mailing Address - Fax:903-792-2051
Practice Address - Street 1:5508 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1822
Practice Address - Country:US
Practice Address - Phone:903-792-1292
Practice Address - Fax:903-792-2051
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL40562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152365601Medicaid
TX300133926OtherRAILROAD MEDICARE
AR148160001Medicaid
TX751708760OtherEIN
TX300133926OtherRAILROAD MEDICARE
TX542148962OtherEIN
TX152365601Medicaid
TX8090B7Medicare ID - Type Unspecified