Provider Demographics
NPI:1386732675
Name:MILLAR, JOSE GABRIEL C (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE GABRIEL
Middle Name:C
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:PO BOX 1255
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78680-1255
Mailing Address - Country:US
Mailing Address - Phone:512-255-7337
Mailing Address - Fax:512-828-0451
Practice Address - Street 1:16010 PARK VALLEY DR
Practice Address - Street 2:STE 300
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3574
Practice Address - Country:US
Practice Address - Phone:512-255-7337
Practice Address - Fax:512-828-0451
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0424208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics