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General NPI Number Information
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NPI Number | 1992460794
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE OB/GYN MEDICAL GROUP INC
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Dates
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Enumeration Date | 11/05/2021
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Last Update Date | 11/06/2021
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Provider Practice Location Address
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Address Line | 1800 WESTERN AVE STE 101
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City | SAN BERNARDINO
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State | CA
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Zip | 92411-1352
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Country | US
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Telephone | 909-885-1542
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10999
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City | SAN BERNARDINO
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State | CA
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Zip | 92423-0999
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Country | US
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Telephone | 909-885-1542
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GEORGE H SMALL
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Credential | MD
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Telephone | 909-528-3639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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