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Organization
OCEAN BEACH MEDICAL GROUP
Active
Organization
OCEAN BEACH MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEOFFRY BRUCE GORDON MD (OWNER)
(619) 223-7164
Entity
Organization
Contact information
Practice address
1947 CABLE ST, SAN DIEGO, CA 92107-2807
(619) 223-7164
(619) 223-5443
Mailing address
1947 CABLE ST, SAN DIEGO, CA 92107-2807
(619) 223-7164
(619) 223-5443
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G19279
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G192790
—
CA
Enumeration date
07/29/2006
Last updated
06/18/2008
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