Provider Demographics
NPI:1275526188
Name:MILLAR, BENJAMIN R (MD)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:R
Last Name:MILLAR
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 1:8715 VILLAGE DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5405
Mailing Address - Country:US
Mailing Address - Phone:210-655-3800
Mailing Address - Fax:210-655-3801
Practice Address - Street 1:8715 VILLAGE DR
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5405
Practice Address - Country:US
Practice Address - Phone:210-655-3800
Practice Address - Fax:210-655-3801
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM74342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT50511Medicaid
TX8F7798Medicare PIN
SCT50511Medicaid