Individual
CHERI L CANON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
619 19TH STREET SOUTH, BIRMINGHAM, AL 35233
(205) 934-4011
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255
(205) 731-9701
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
19302
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000076770
—
AL
05
—
009937021
—
AL
01
—
010033CG73405
SECTION 1011
AL
01
—
051505897
BCBS
AL
01
—
051512192
BCBS
AL
01
—
051534539
BCBS
AL
01
—
76770
BCBS
AL
01
—
G73405
VIVA
AL
01
—
G73405
VIVA
—
Enumeration date
06/08/2006
Last updated
07/20/2011
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