Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 21 | TX |
NPI | 1033169289 |
---|---|
Provider Name | Mr. William Alexander Millar |
First Address | Wichita Falls, TX 76301-4312 |
Second Address | Wichita Falls, TX 76301-4312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
514542 | BLUE CROSS IDENTIFIER (01) | TX |