Provider Demographics
NPI:1215046065
Name:FAMILY PRACTICE MEDICAL GROUP
Entity Type:Organization
Organization Name:FAMILY PRACTICE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INC
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:T
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-687-1505
Mailing Address - Street 1:200 N LA CUMBRE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1577
Mailing Address - Country:US
Mailing Address - Phone:805-687-1505
Mailing Address - Fax:805-682-8241
Practice Address - Street 1:200 N LA CUMBRE RD
Practice Address - Street 2:#E
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1577
Practice Address - Country:US
Practice Address - Phone:805-687-1505
Practice Address - Fax:805-682-8241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty