Provider Demographics
NPI:1205934957
Name:MILLIGAN, LYNDA BETH (MD)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:BETH
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3729
Mailing Address - Country:US
Mailing Address - Phone:501-315-1222
Mailing Address - Fax:501-315-1241
Practice Address - Street 1:5 MEDICAL PARK DR
Practice Address - Street 2:SUITE 102A
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3729
Practice Address - Country:US
Practice Address - Phone:501-315-1222
Practice Address - Fax:501-315-1241
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR90648600040OtherQUALCHOICE
AR7746038OtherAETNA
AR131399001Medicaid
AR383877OtherHEALTHLINK
ARG38851Medicare UPIN
AR131399001Medicare PIN
AR7746038OtherAETNA
AR90648600040OtherQUALCHOICE
AR5K304Medicare ID - Type Unspecified