1164680070 NPI number — CANDICE ANNE MARCUM SAUDER MD

Table of content: MRS. LORI SELFRIDGE CRNP (NPI 1255601712)

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".