Provider Demographics
NPI:1114142304
Name:ROBERT L MCGHIE MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ROBERT L MCGHIE MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCGHIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-928-7951
Mailing Address - Street 1:PO BOX 5939
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93456-5939
Mailing Address - Country:US
Mailing Address - Phone:805-928-7951
Mailing Address - Fax:805-928-6839
Practice Address - Street 1:210 S PALISADE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8901
Practice Address - Country:US
Practice Address - Phone:805-928-7951
Practice Address - Fax:805-928-6839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53248207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN374415OtherNURSE PRACTITIONER
CAA52480Medicare UPIN