Provider Demographics
NPI:1447539374
Name:NORTHERN CALIFORNIA CANCER CENTER
Entity type:Organization
Organization Name:NORTHERN CALIFORNIA CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHARIMAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:209-544-0120
Mailing Address - Street 1:1541 FLORIDA AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4429
Mailing Address - Country:US
Mailing Address - Phone:209-544-0120
Mailing Address - Fax:209-544-0130
Practice Address - Street 1:1541 FLORIDA AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4429
Practice Address - Country:US
Practice Address - Phone:209-544-0120
Practice Address - Fax:209-544-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75542207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty