# DR. JERRY CANNADAY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1194774646
- **Gender:** Man
- **Credential:** DO

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | D7542 | TX | — |
| 207Q00000X | Family Medicine Physician | R-4722 | AR | — |
| 208D00000X | General Practice Physician | R-4722 | AR | Yes |

## Other

- **Enumeration date:** 05/10/2006
- **Last updated:** 01/13/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 080095891 | RR MEDICARE | TX |
| 05 | — | 1341125-04 | — | TX |
| 01 | — | 84Z865 | BCBS | TX |