Individual
MICHAEL CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
301 NW F ST, GRANTS PASS, OR 97526-2051
(541) 474-5177
(541) 474-5181
Mailing address
301 NW F ST, GRANTS PASS, OR 97526-2051
(541) 474-5177
(541) 474-5181
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/02/2018
Last updated
03/02/2018
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