Provider Demographics
NPI:1104980416
Name:MILLIKAN, LARRY E (MD FAAD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:E
Last Name:MILLIKAN
Suffix:
Gender:M
Credentials:MD FAAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3940
Mailing Address - Country:US
Mailing Address - Phone:601-484-9490
Mailing Address - Fax:601-486-2457
Practice Address - Street 1:2321 13TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3940
Practice Address - Country:US
Practice Address - Phone:601-484-9490
Practice Address - Fax:601-486-2457
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10582207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology