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General NPI Number Information
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NPI Number | 1528068731
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Entity Type | Organization
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Legal Business Name | SIERRA RADIATION ONCOLOGY A MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 155 GLASSON WAY SUITE L20
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City | GRASS VALLEY
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State | CA
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Zip | 95945-5723
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Country | US
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Telephone | 530-274-6600
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Fax | 530-274-6629
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Provider Business Mailing Address
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Address Line | PO BOX 689
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City | BOALSBURG
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State | PA
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Zip | 16827-0689
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Country | US
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Telephone | 814-237-8627
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Fax | 814-238-0083
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DAVID J KRAUS
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Credential | MD
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Telephone | 530-274-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State | CA
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