Organization
CANCER THERAPY MEDICAL GROUP INC
Active
Parent organization
CANCER THERAPY MEDICAL GROUP
Other names
South Sacramento Cancer Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
CANCER THERAPY MEDICAL GROUP
Authorized official
JONATHAN HUMPHREY MD (MEDICAL DIRECTOR)
(925) 952-8700
Entity
Organization
Contact information
Practice address
8100 BRUCEVILLE RD, SACRAMENTO, CA 95823-2353
(916) 683-9616
(916) 688-1320
Mailing address
PO BOX 756, DANVILLE, CA 94526-0756
(877) 866-0914
(209) 343-3809
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA253850
MEDICARE
CA
01
—
DC7191
RAILROAD MEDICARE
—
01
—
ZZZ50269Z
BLUE SHIELD
—
Enumeration date
08/09/2006
Last updated
04/04/2023
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