Healthcare Provider Details

I. General information

NPI: 1437476439
Provider Name (Legal Business Name): SAMER S. OTHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SANTA ROSA ST STE 201
SAN LUIS OBISPO CA
93405
US

IV. Provider business mailing address

PO BOX 14632
SAN LUIS OBISPO CA
93406-4632
US

V. Phone/Fax

Practice location:
  • Phone: 805-544-7246
  • Fax: 805-782-8097
Mailing address:
  • Phone: 626-800-7617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA118624
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA118624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: