Healthcare Provider Details

I. General information

NPI: 1114142304
Provider Name (Legal Business Name): ROBERT L MCGHIE MD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2007
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S PALISADE DR SUITE 102
SANTA MARIA CA
93454-8901
US

IV. Provider business mailing address

PO BOX 5939
SANTA MARIA CA
93456-5939
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-7951
  • Fax: 805-928-6839
Mailing address:
  • Phone: 805-928-7951
  • Fax: 805-928-6839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberG53248
License Number StateCA

VIII. Authorized Official

Name: ROBERT L MCGHIE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-928-7951