Provider Demographics
NPI:1740281385
Name:MCMILLAN, DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
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:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1325
Mailing Address - Country:US
Mailing Address - Phone:903-792-1292
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:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD98522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110504001Medicaid
TX300039218OtherRAILROAD MEDICARE
TX103362301Medicaid
TX103362301Medicaid
C19211Medicare UPIN
TX82R608Medicare ID - Type Unspecified
AR110504001Medicaid