Healthcare Provider Details

I. General information

NPI: 1033169289
Provider Name (Legal Business Name): WILLIAM ALEXANDER MILLAR ABC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: WILLIAM ALEXANDER MILLAR ABC

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 HOLLIDAY ST
WICHITA FALLS TX
76301-4312
US

IV. Provider business mailing address

905 HOLLIDAY ST
WICHITA FALLS TX
76301-4312
US

V. Phone/Fax

Practice location:
  • Phone: 940-322-4647
  • Fax: 940-322-9806
Mailing address:
  • Phone: 940-322-4647
  • Fax: 940-322-9806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number21
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: