Organization
CARITAS FAMILY MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY ALEXANDER CANNON MD (PRESIDENT)
(210) 650-9066
Entity
Organization
Contact information
Practice address
11901 TOEPPERWEIN RD, SUITE 1201, LIVE OAK, TX 78233-3161
(210) 650-9066
(210) 650-9067
Mailing address
11901 TOEPPERWEIN RD, SUITE 1201, LIVE OAK, TX 78233-3161
(210) 650-9066
(210) 650-9067
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
L8002
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010025319
RAILROAD MEDICARE
TX
05
—
112162601
—
TX
01
—
8P1540
BLUE CROSS
TX
01
—
8P1541
BLUE CROSS
TX
01
—
P00178727
RAILROAD MEDICARE
TX
Enumeration date
08/20/2006
Last updated
04/05/2017
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