Basic Information
| Provider Information | |||||||||
| NPI: | 1740281385 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCMILLAN | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1325 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462061325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037921292 | ||||||||
| FaxNumber: | 9037922051 | ||||||||
| Practice Location | |||||||||
| Address1: | 5508 SUMMERHILL RD | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755031822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037921292 | ||||||||
| FaxNumber: | 9037922051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2005 | ||||||||
| LastUpdateDate: | 03/12/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | D9852 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 110504001 | 05 | AR | MEDICAID | 300039218 | 01 | TX | RAILROAD MEDICARE | OTHER | 103362301 | 05 | TX | MEDICAID |