Provider Demographics
NPI:1316995426
Name:MILNER, SANFORD JACK (DPM)
Entity type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:JACK
Last Name:MILNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:MILNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:3901 LAS POSAS RD
Mailing Address - Street 2:#201
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1501
Mailing Address - Country:US
Mailing Address - Phone:805-484-1333
Mailing Address - Fax:805-482-4374
Practice Address - Street 1:3901 LAS POSAS RD
Practice Address - Street 2:#201
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1505
Practice Address - Country:US
Practice Address - Phone:805-484-1333
Practice Address - Fax:805-482-4374
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1717213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT19131Medicare UPIN
CAE1717Medicare ID - Type Unspecified