Individual
NATHAN ALLEN CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D./PH.D.
Contact information
Practice address
11050 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845
(260) 266-9100
Mailing address
7910 W JEFFERSON BLVD STE 110, FORT WAYNE, IN 46804-4159
(260) 436-4116
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
01075113A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0134869
—
OH
05
—
201292540
—
IN
Enumeration date
08/17/2010
Last updated
06/15/2018
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