1164680070 NPI number — CANDICE ANNE MARCUM SAUDER MD

Table of content: CANDICE ANNE MARCUM SAUDER MD (NPI 1164680070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164680070 NPI number — CANDICE ANNE MARCUM SAUDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAUDER
Provider First Name:
CANDICE
Provider Middle Name:
ANNE MARCUM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARCUM
Provider Other First Name:
CANDICE
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164680070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UC DAVIS CANCER CENTER
Provider Second Line Business Mailing Address:
4501 X STREET, SUITE 3010
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95817-2229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-734-5907
Provider Business Mailing Address Fax Number:
916-703-5267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UC DAVIS CANCER CENTER
Provider Second Line Business Practice Location Address:
4501 X STREET, SUITE 3010
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-2229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-5907
Provider Business Practice Location Address Fax Number:
916-703-5267
Provider Enumeration Date:
05/28/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  A140377 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086X0206X , with the licence number: A140377 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: A140377 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 341619001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".