Organization
CMG MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN B. GOODMAN M.D. (PRESIDENT)
(805) 771-8365
Entity
Organization
Contact information
Practice address
665 MAIN ST, SUITE B, MORRO BAY, CA 93442-2269
(805) 771-8365
(805) 771-9242
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
—
GR0069892
—
CA
01
—
ZZZ55765Z
BLUE SHIELD OF CA
CA
Enumeration date
10/30/2006
Last updated
10/18/2007
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