Provider Demographics
NPI:1427133081
Name:SQUIERS, MILTON D (MD)
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:D
Last Name:SQUIERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-6726
Practice Address - Fax:682-885-6729
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7927208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140442810Medicaid
TX00U87ZOtherBCBSTX GRP PIN
TX129529701Medicaid
TX1684390OtherUHC PIN
TX89662YOtherBCBSTX IND PIN
1750369203OtherGRP NPI NUMBER
TX2815643OtherCIGNA PIN
TX1822884OtherFIRSTHEALTH PIN
TX5347105OtherAETNA PIN
TX140442810Medicaid