Organization
CANCER THERAPY MEDICAL GROUP INC
Active
Parent organization
CANCER THERAPY MEDICAL GROUP INC
Other names
Rohnert Park Cancer Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
CANCER THERAPY MEDICAL GROUP INC
Authorized official
DR. JONATHAN HUMPHREY MD (MEDICAL DIRECTOR)
(925) 952-8700
Entity
Organization
Contact information
Practice address
301 PROFESSIONAL CENTER DR, ROHNERT PARK, CA 94928-2152
(707) 584-2200
(707) 584-7582
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
—
DC7191
RAILROAD MCARE
—
05
—
GR0092410
—
CA
01
—
ZZZ04964Z
BLUE SHIELD
—
Enumeration date
08/09/2006
Last updated
04/04/2023
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