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Individual
DR. JERRY CANNADAY
Active
Individual
DR. JERRY CANNADAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
D7542
TX
207Q00000X
Family Medicine Physician
R-4722
AR
208D00000X
General Practice Physician
Primary
R-4722
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080095891
RR MEDICARE
TX
05
—
1341125-04
—
TX
01
—
84Z865
BCBS
TX
Enumeration date
05/10/2006
Last updated
01/13/2017
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