Organization
CANCER THERAPY MEDICAL GROUP INC
Active
Parent organization
CANCER THERAPY MEDICAL GROUP INC
Other names
Fresno Cancer Center & Central Valley Breast Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
CANCER THERAPY MEDICAL GROUP INC
Authorized official
JONATHAN HUMPHREY MD (MEDICAL DIRECTOR)
(925) 952-8700
Entity
Organization
Contact information
Practice address
7887 N CEDAR AVE, FRESNO, CA 93720-2685
(559) 437-1000
(559) 437-3870
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
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QX0200X
Oncology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC7191
RAILROAD MEDICARE
—
05
—
GR0092411
—
CA
01
—
ZZZ208856Z
BLUE SHIELD
—
Enumeration date
08/09/2006
Last updated
04/04/2023
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