Provider Demographics
NPI:1033169289
Name:MILLAR, WILLIAM ALEXANDER (ABC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ALEXANDER
Last Name:MILLAR
Suffix:
Gender:M
Credentials:ABC
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:ALEXANDER
Other - Last Name:MILLAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ABC
Mailing Address - Street 1:905 HOLLIDAY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4312
Mailing Address - Country:US
Mailing Address - Phone:940-322-4647
Mailing Address - Fax:940-322-9806
Practice Address - Street 1:905 HOLLIDAY ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4312
Practice Address - Country:US
Practice Address - Phone:940-322-4647
Practice Address - Fax:940-322-9806
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX514542OtherBLUE CROSS IDENTIFIER
TX0349550001Medicare ID - Type UnspecifiedMEDICARE BILLING NUMBER