Individual
DR. JERRY CANNADAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
121 CORDOBA CENTER DR, SUITE 400, HOT SPRINGS, AR 71909-4030
(501) 915-0837
(501) 915-0978
Mailing address
121 CORDOBA CENTER DR, SUITE 400, HOT SPRINGS, AR 71909-4030
(501) 915-0837
(501) 915-0978
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
D7542
TX
207Q00000X
Family Medicine Physician
R-4722
AR
208D00000X
General Practice Physician
Primary
R-4722
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080095891
RR MEDICARE
TX
05
—
1341125-04
—
TX
01
—
84Z865
BCBS
TX
Enumeration date
05/10/2006
Last updated
01/13/2017
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