Individual
MR. TY CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
616 S RIVER RD STE 200, ST GEORGE, UT 84790-2105
(435) 628-8944
Mailing address
150 N 1100 E UNIT 50, WASHINGTON, UT 84780-2883
(435) 231-2961
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10974132-1206
UT
Other
Enumeration date
09/25/2018
Last updated
09/25/2018
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