Provider Demographics
NPI:1437476439
Name:OTHMAN, SAMER S (MD)
Entity Type:Individual
Prefix:
First Name:SAMER
Middle Name:S
Last Name:OTHMAN
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:PO BOX 14632
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-4632
Mailing Address - Country:US
Mailing Address - Phone:626-800-7617
Mailing Address - Fax:
Practice Address - Street 1:10 SANTA ROSA ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405
Practice Address - Country:US
Practice Address - Phone:805-544-7246
Practice Address - Fax:805-782-8097
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118624208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12609001OtherCAQH PROVIDER NUMBER
CAA118624OtherCA MEDICAL BOARD LICENSE