Provider Demographics
NPI:1629063946
Name:MILLER, MARK F (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:F
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8028
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:2801 SANTA MARIA WAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-2118
Practice Address - Country:US
Practice Address - Phone:805-934-5400
Practice Address - Fax:805-938-9207
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE-3301213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3301OtherLIC
CAAM3224324OtherDEA
CAE3301OtherLIC
CAZZZ22507ZMedicare PIN