Individual
GABRIEL CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.D.N.
Contact information
Practice address
326 N MADISON AVE, BLANCHARD, OK 73010-5929
(405) 413-7456
Mailing address
326 N MADISON AVE, BLANCHARD, OK 73010-5929
(405) 413-7456
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
2126
OK
133V00000X
Registered Dietitian
Primary
2126
OK
Other
Enumeration date
09/02/2016
Last updated
09/02/2016
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