Provider Demographics
NPI:1568411221
Name:AFPMG INC
Entity Type:Organization
Organization Name:AFPMG INC
Other - Org Name:ALMADEN FAMILY PHYSICIANS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-997-9155
Mailing Address - Street 1:PO BOX 20700
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95160
Mailing Address - Country:US
Mailing Address - Phone:408-997-9155
Mailing Address - Fax:408-997-9106
Practice Address - Street 1:6475 CAMDEN AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120
Practice Address - Country:US
Practice Address - Phone:408-997-9155
Practice Address - Fax:408-997-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63442207Q00000X
CAG57512207Q00000X
CAG62536207Q00000X
CAC25075207Q00000X
CAG57420207Q00000X
CAA94465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A53296OtherJEFFREY C ETTINGER MD
F03405Medicare UPIN
A53296OtherJEFFREY C ETTINGER MD
A57360Medicare UPIN
A32783Medicare UPIN
CAZZZ00327ZMedicare ID - Type Unspecified
G72016Medicare UPIN