Healthcare Provider Details

I. General information

NPI: 1619066693
Provider Name (Legal Business Name): SAMUEL DEAN MILLER IV D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E CHURCH ST
SANTA MARIA CA
93454-5906
US

IV. Provider business mailing address

531 CUESTA PL
ARROYO GRANDE CA
93420-2001
US

V. Phone/Fax

Practice location:
  • Phone: 805-739-3000
  • Fax:
Mailing address:
  • Phone: 714-390-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4349
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number20A9888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: