Individual
DR. LACEY MCMILLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
630 S FLEISHEL AVE, TYLER, TX 75701-2041
(903) 606-5560
Mailing address
27617 TIERRA DEL SOL LN, BONITA SPRINGS, FL 34135-3553
(305) 619-1680
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
TRN23830
FL
2086S0102X
Surgical Critical Care Physician
1017531
MA
2086S0127X
Trauma Surgery Physician
0101286193
VA
2086S0127X
Trauma Surgery Physician
1017531
MA
2086S0127X
Trauma Surgery Physician
2024044388
MO
2086S0127X
Trauma Surgery Physician
2026-00086
NC
2086S0127X
Trauma Surgery Physician
DR.0068531
CO
2086S0127X
Trauma Surgery Physician
ME148659
FL
2086S0127X
Trauma Surgery Physician
Primary
T3133
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111265500
—
FL
01
—
U9993
MEDICARE HF
FL
01
—
U9996
MEDICARE HFPS
FL
Enumeration date
06/16/2016
Last updated
03/18/2026
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