MEDICARE: AFPMG 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
1	207Q00000X	Family Medicine Physician	A63442	CA
2	207Q00000X	Family Medicine Physician	G57512	CA
3	207Q00000X	Family Medicine Physician	G62536	CA
4	207Q00000X	Family Medicine Physician	C25075	CA
5	207Q00000X	Family Medicine Physician	A94465	CA
6	207Q00000X	Family Medicine Physician	G57420	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A53296	OTHER		JEFFREY C ETTINGER MD

General Provider Information

NPI Number	:	1568411221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFPMG INC

Provider Business Mailing Address
First Line	:	PO BOX 20700
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95160
Country	:	US
Telephone Number	:	408-997-9155
Fax Number	:	408-997-9106

Provider Business Practice Location Address
First Line	:	6475 CAMDEN AVE
Second Line	:	SUITE 105
City	:	SAN JOSE
State	:	CA
Zip	:	95120
Country	:	US
Telephone Number	:	408-997-9155
Fax Number	:	408-997-9106

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID W MCCULLOUGH
Credential	:	MD
Telephone Number	:	408-997-9155

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	08/22/2020

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Directions to “AFPMG INC ” Practice Location

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