Provider Demographics
NPI:1811964216
Name:MILHOAN, RUSTY ALLEN (MD)
Entity type:Individual
Prefix:
First Name:RUSTY
Middle Name:ALLEN
Last Name:MILHOAN
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 1:3150 MATLOCK RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2992
Mailing Address - Country:US
Mailing Address - Phone:817-375-9790
Mailing Address - Fax:817-375-9791
Practice Address - Street 1:3150 MATLOCK RD
Practice Address - Street 2:SUITE 401
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2992
Practice Address - Country:US
Practice Address - Phone:817-375-9790
Practice Address - Fax:817-375-9791
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1303174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139964401Medicaid
TX2319377OtherBLUECROSSBLUESHIELD
TX5700162OtherAETNA
TX161676686OtherTRICARE
TX5700162OtherAETNA
TX00T27SMedicare PIN