Provider Demographics
NPI:1700093226
Name:CANTER, ROBERT JONATHAN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JONATHAN
Last Name:CANTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 X ST
Mailing Address - Street 2:SUITE 3010
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2229
Mailing Address - Country:US
Mailing Address - Phone:916-734-7044
Mailing Address - Fax:916-703-5267
Practice Address - Street 1:4501 X ST STE 3010
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2229
Practice Address - Country:US
Practice Address - Phone:916-734-5907
Practice Address - Fax:916-703-5267
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1012042086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1012040Medicare PIN