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Individual
STEPHEN JEROME CANNON
Active
Individual
STEPHEN JEROME CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
28237950A
IN
367500000X
Certified Registered Nurse Anesthetist
AP115468
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP9205700
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001096178
ANTHEM PROVIDER NUMBER
IN
05
—
009982295
—
AL
05
—
300004501
—
IN
01
—
59169960
BCBS
AL
01
—
59169961
BCBS
AL
01
—
G1321
BCBS
FL
01
—
P00166590
PALMETTO GBA-RR MEDICARE
—
Enumeration date
05/16/2006
Last updated
05/03/2023
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