Organization
CMG MEDICAL GROUP INC
Active
Other names
CMG MEDICAL GROUP INC
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN B GOODMAN MD (PRESIDENT)
(805) 543-4043
Entity
Organization
Contact information
Practice address
5920 WEST MALL, ATASCADERO, CA 93422-4232
(805) 466-0676
(805) 466-8276
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
1935201
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
183948201
USDOL PROVIDER ID
—
05
—
GR0069890
—
CA
01
—
ZZZ54100Z
BLUE SHIELD OF CA
CA
Enumeration date
11/08/2006
Last updated
09/16/2011
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