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Organization
CMG MEDICAL GROUP INC
Active
Organization
CMG MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN B GOODMAN MD (PRESIDENT)
(805) 543-4043
Entity
Organization
Contact information
Practice address
1555 HIGUERA ST, SAN LUIS OBISPO, CA 93401-2917
(805) 543-4043
(805) 543-4427
Mailing address
1555 HIGUERA ST, SAN LUIS OBISPO, CA 93401-2917
(805) 543-4043
(805) 543-4427
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C1935201
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0069893
—
CA
01
—
ZZZ0515Z
BLUE SHIELD OF CA
CA
Enumeration date
05/27/2006
Last updated
03/18/2011
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