Individual
MARY MILAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1307 8TH AVE, SUITE 205, FORT WORTH, TX 76104-4137
(817) 924-4300
(817) 924-1493
Mailing address
1307 8TH AVE, SUITE 308, FORT WORTH, TX 76104-4140
(817) 920-0638
(817) 920-0690
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
E4529
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356156-04
—
TX
Enumeration date
05/24/2005
Last updated
07/15/2008
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