Provider Demographics
NPI:1003967423
Name:MILLER, ERNEST BURTON
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:BURTON
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 CALIFORNIA BLVD
Mailing Address - Street 2:SUITE Q
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2541
Mailing Address - Country:US
Mailing Address - Phone:805-541-0502
Mailing Address - Fax:805-541-0503
Practice Address - Street 1:620 CALIFORNIA BLVD
Practice Address - Street 2:SUITE Q
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2541
Practice Address - Country:US
Practice Address - Phone:805-541-0502
Practice Address - Fax:805-541-0503
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41913207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery