# BRYAN JAMES CANNON

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

## Provider details

- **NPI number:** 1265662068
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 2016016732 | MO | Yes |
| 207Q00000X | Family Medicine Physician | 6038 | NE | — |

## Other

- **Enumeration date:** 07/15/2009
- **Last updated:** 02/08/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1265662068 | — | MO |