Provider Demographics
NPI:1255441762
Name:MILLICAN, GEOFFREY M (MD)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:M
Last Name:MILLICAN
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 1:7940 FLOYD CURL DR
Mailing Address - Street 2:SUITE 560
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3905
Mailing Address - Country:US
Mailing Address - Phone:210-692-7400
Mailing Address - Fax:210-692-0090
Practice Address - Street 1:7940 FLOYD CURL DR
Practice Address - Street 2:SUITE 560
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3905
Practice Address - Country:US
Practice Address - Phone:210-692-7400
Practice Address - Fax:210-692-0090
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM3024207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM3024OtherTEXAS LICENSE NUMBER
TX20-4584500OtherINDIVIDUAL TAX ID
TX8F4228Medicare PIN
TXM3024OtherTEXAS LICENSE NUMBER