Provider Demographics
NPI:1972526598
Name:MCMILLAN, ROBERT W (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2751 ALBERT BICKNELL DR
Mailing Address - Street 2:STE 4A
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103
Mailing Address - Country:US
Mailing Address - Phone:318-212-4275
Mailing Address - Fax:318-212-8511
Practice Address - Street 1:2751 ALBERT BICKNELL DR
Practice Address - Street 2:STE. 4A
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103
Practice Address - Country:US
Practice Address - Phone:318-212-4275
Practice Address - Fax:318-212-8511
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06902R208600000X, 204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5K315F600OtherMEDICARE - PTAN
LA1390801Medicaid
LA1390801Medicaid