Provider Demographics
NPI:1164680070
Name:SAUDER, CANDICE ANNE MARCUM (MD)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:ANNE MARCUM
Last Name:SAUDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:ANNE
Other - Last Name:MARCUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:UC DAVIS CANCER CENTER
Mailing Address - Street 2:4501 X STREET, SUITE 3010
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2229
Mailing Address - Country:US
Mailing Address - Phone:916-734-5907
Mailing Address - Fax:916-703-5267
Practice Address - Street 1:UC DAVIS CANCER CENTER
Practice Address - Street 2:4501 X STREET, SUITE 3010
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?:No
Enumeration Date:2008-05-28
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA140377208600000X, 2086X0206X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341619001Medicaid
TX375321YKQHMedicare PIN