Provider Demographics
NPI:1437248549
Name:ARBOR MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ARBOR MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:EBNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-928-3678
Mailing Address - Street 1:1418 E MAIN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4802
Mailing Address - Country:US
Mailing Address - Phone:805-928-3678
Mailing Address - Fax:805-928-6408
Practice Address - Street 1:1418 E MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4802
Practice Address - Country:US
Practice Address - Phone:805-928-3678
Practice Address - Fax:805-928-6408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10404DOtherMEDICARE GROUP NUMBER
DA4332OtherMEICARE RR
DA4332OtherMEICARE RR