Provider Demographics
NPI:1689628224
Name:MILLIEN, GARRY DAVIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:DAVIS
Last Name:MILLIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1501 FOREST HILL BLVD
Mailing Address - Street 2:103
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6000
Mailing Address - Country:US
Mailing Address - Phone:561-432-5090
Mailing Address - Fax:561-433-1565
Practice Address - Street 1:1501 FOREST HILL BLVD
Practice Address - Street 2:103
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6000
Practice Address - Country:US
Practice Address - Phone:561-432-5090
Practice Address - Fax:561-433-1565
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0066418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01-02503OtherUNITED HEALTH CARE
FL32570OtherBCBS
FL250250001Medicaid
FL228-6290OtherAETNA
FLME0066418OtherMEDICAL LICENSE
FLME0066418OtherMEDICAL LICENSE
FL32570OtherBCBS