Provider Demographics
NPI:1669458014
Name:MARMOR, C JANE BREEDEN (MD)
Entity Type:Individual
Prefix:
First Name:C JANE
Middle Name:BREEDEN
Last Name:MARMOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 MIRADA AVE
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-8476
Mailing Address - Country:US
Mailing Address - Phone:650-323-0754
Mailing Address - Fax:650-323-0764
Practice Address - Street 1:170 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:DEPT OF RADIATION ONCOLOGY SEQUOIA HOSPITAL
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2799
Practice Address - Country:US
Practice Address - Phone:650-245-3889
Practice Address - Fax:650-323-0764
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG139792085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G139790OtherBLUE SHIELD
CA00G139790Medicaid
CA00G139790OtherBLUE SHIELD
CA00G139790Medicaid