Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 4484 | KS |
NPI | 1003910092 |
---|---|
Provider Name | Michael Louis Milford |
First Address | Dodge City, KS 67801 |
Second Address | Dodge City, KS 67801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008872 | BLUE CROSS BLUE SHIELD (01) | KS |
T44048 | (02) |