Provider Demographics
NPI:1609877737
Name:MILLARD, MARK W (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:MILLARD
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:LB-143
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246
Mailing Address - Country:US
Mailing Address - Phone:214-827-0067
Mailing Address - Fax:214-827-8840
Practice Address - Street 1:4004 WORTH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:214-820-3500
Practice Address - Fax:214-820-9799
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2023-07-05
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Provider Licenses
StateLicense IDTaxonomies
TXG0775207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120516304Medicaid
TXC19380Medicare UPIN