Healthcare Provider Details

I. General information

NPI: 1700093226
Provider Name (Legal Business Name): ROBERT JONATHAN CANTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 X ST STE 3010
SACRAMENTO CA
95817-2229
US

IV. Provider business mailing address

4501 X ST SUITE 3010
SACRAMENTO CA
95817-2229
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5907
  • Fax: 916-703-5267
Mailing address:
  • Phone: 916-734-7044
  • Fax: 916-703-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA101204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: