Provider Demographics
NPI:1184727711
Name:MILMORE, DONALD ERIC (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:ERIC
Last Name:MILMORE
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 1:120 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-2028
Mailing Address - Country:US
Mailing Address - Phone:315-637-4601
Mailing Address - Fax:315-637-8927
Practice Address - Street 1:120 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-2028
Practice Address - Country:US
Practice Address - Phone:315-637-4601
Practice Address - Fax:315-637-8927
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128413208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00376132Medicaid
NY00376132Medicaid
NY394030Medicare PIN
B81791Medicare UPIN