Healthcare Provider Details

I. General information

NPI: 1528068731
Provider Name (Legal Business Name): SIERRA RADIATION ONCOLOGY A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 GLASSON WAY SUITE L20
GRASS VALLEY CA
95945-5723
US

IV. Provider business mailing address

PO BOX 689
BOALSBURG PA
16827-0689
US

V. Phone/Fax

Practice location:
  • Phone: 530-274-6600
  • Fax: 530-274-6629
Mailing address:
  • Phone: 814-237-8627
  • Fax: 814-238-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DAVID J KRAUS
Title or Position: PHYSICIAN
Credential: MD
Phone: 530-274-6600