Provider Demographics
NPI:1265650196
Name:MILLER, GLENN ELLIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ELLIOTT
Last Name:MILLER
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 1:629 STATE ST STE 245
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-7074
Mailing Address - Country:US
Mailing Address - Phone:805-965-4005
Mailing Address - Fax:805-965-8186
Practice Address - Street 1:629 STATE ST STE 245
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-7074
Practice Address - Country:US
Practice Address - Phone:805-965-4005
Practice Address - Fax:805-965-8186
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG544012084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine