Healthcare Provider Details

I. General information

NPI: 1659381549
Provider Name (Legal Business Name): CANCER THERAPY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7887 N CEDAR AVE
FRESNO CA
93720-2685
US

IV. Provider business mailing address

PO BOX 756
DANVILLE CA
94526-0756
US

V. Phone/Fax

Practice location:
  • Phone: 559-437-1000
  • Fax: 559-437-3870
Mailing address:
  • Phone: 877-866-0914
  • Fax: 209-343-3809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN HUMPHREY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 925-952-8700