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General NPI Number Information
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NPI Number | 1649280520
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Entity Type | Organization
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Legal Business Name | CANCER THERAPY MEDICAL GROUP INC
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 301 PROFESSIONAL CENTER DR
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City | ROHNERT PARK
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State | CA
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Zip | 94928-2152
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Country | US
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Telephone | 707-584-2200
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Fax | 707-584-7582
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Provider Business Mailing Address
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Address Line | PO BOX 756
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City | DANVILLE
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State | CA
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Zip | 94526-0756
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Country | US
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Telephone | 877-866-0914
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Fax | 209-343-3809
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JONATHAN HUMPHREY
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Credential | MD
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Telephone | 925-952-8700
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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 |
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