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Individual
DANIEL CANNON
Active
Individual
DANIEL CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
11968682-1205
UT
208000000X
Pediatrics Physician
Primary
49302
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49302
MEDICAL LICENSE
AZ
05
—
701112
—
AZ
Enumeration date
06/23/2011
Last updated
10/13/2020
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