Individual
SCOTT LAWRENCE CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1650 COWLES ST, FAIRBANKS, AK 99701-5925
(907) 458-5650
(907) 456-8050
Mailing address
315 ILLINOIS ST, FAIRBANKS, AK 99701-2910
(907) 456-7767
(907) 456-8050
Taxonomy
Speciality
Code
Description
License number
State
246Q00000X
Pathology Specialist/Technologist
Primary
3351
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220030113
MEDICARE RR
AK
05
—
MD3351
—
AK
Enumeration date
05/12/2006
Last updated
12/09/2010
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