Organization
JAY CANNON MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY P CANNON MD (OWNER)
(405) 945-4240
Entity
Organization
Contact information
Practice address
3435 NW 56TH ST STE 210, OKLAHOMA CITY, OK 73112-4414
(405) 945-4240
(405) 945-4242
Mailing address
3435 NW 56TH ST STE 210, OKLAHOMA CITY, OK 73112-4414
(405) 945-4240
(405) 945-4242
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
9490
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100104400A
—
OK
Enumeration date
02/26/2007
Last updated
06/17/2008
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