Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2818 | AR |
NPI | 1003910001 |
---|---|
Provider Name | Dr. Philip E Milam |
First Address | Harrison, AR 72601-3442 |
Second Address | Harrison, AR 72601-3442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 03/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
127337679 | (05) | AR |
152666680 | (05) | AR |
T20406 | (02) |