Individual
DR. CHARLES LAWRENCE CANNON
Active
Individual
DR. CHARLES LAWRENCE CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
17275
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
TRICARE REGION 6
OK
01
—
100007598
RAILROAD MEDICARE
GA
05
—
100088540A
—
OK
Enumeration date
06/27/2005
Last updated
12/11/2012
Update your record
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