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Organization

JENNIFER C CANNON, DO, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JENNIFER C CANNON D.O. (OWNER/MEMBER MANAGER)
(480) 544-2599
Entity
Organization

Contact information

Practice address
4611 E PALO VERDE DR, PHOENIX, AZ 85018-1258
(480) 544-2599
(602) 840-1290
Mailing address
4611 E PALO VERDE DR, PHOENIX, AZ 85018-1258
(480) 544-2599
(602) 840-1290

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
7114
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P-2167485-1
ARIZONA CORPORATION #
AZ
Enumeration date
04/05/2017
Last updated
04/05/2017
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