Organization
MARY MILAM, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY MILAM M.D., P.A (OWNER)
(817) 924-4300
Entity
Organization
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 205, FORT WORTH, TX 76104-4137
(817) 924-4300
(817) 924-1493
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
E4529
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135615604
—
TX
Enumeration date
07/02/2008
Last updated
07/14/2008
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