Organization
CANNON FAMILY MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN R CANNON MD (OWNER)
(337) 783-5900
Entity
Organization
Contact information
Practice address
719 N EASTERN AVE, CROWLEY, LA 70526-3856
(337) 783-5900
(337) 783-5914
Mailing address
719 N EASTERN AVE, CROWLEY, LA 70526-3856
(337) 783-5900
(337) 783-5914
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
025690
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1048577
—
LA
Enumeration date
12/15/2006
Last updated
03/24/2008
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