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NPI Code Detail

MEDICARE: CMG MEDICAL GROUP INC

MEDICARE: CMG MEDICAL GROUP INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianC1935201CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2ZZZ0515ZOTHERCABLUE SHIELD OF CA

General Provider Information

NPI Number : 1447207535
Entity Type Code : Organization
Provider Name (Legal Business Name) : CMG MEDICAL GROUP INC
Provider Business Mailing Address
First Line : 1555 HIGUERA ST
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-2917
Country : US
Telephone Number : 805-543-4043
Fax Number : 805-543-4427
Provider Business Practice Location Address
First Line : 1555 HIGUERA ST
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-2917
Country : US
Telephone Number : 805-543-4043
Fax Number : 805-543-4427
Authorized Official
Title or Position : PRESIDENT
Name : STEVEN B GOODMAN
Credential : MD
Telephone Number : 805-543-4043
Provider Enumeration Date : 05/27/2006
Last Update Date : 03/18/2011

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Directions to “CMG MEDICAL GROUP INC ” Practice Location

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