Individual
DR. CAROLYN L CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD PHD
Contact information
Practice address
5323 HARRY HINES BLVD, DALLAS, TX 75390-7201
(214) 456-2857
(214) 456-5406
Mailing address
2900 E 29TH ST, STE 100, BRYAN, TX 77802-2623
(979) 436-0501
(979) 776-6905
Taxonomy
Speciality
Code
Description
License number
State
2080P0201X
Pediatric Allergy/Immunology Physician
2003014838
MO
2080P0214X
Pediatric Pulmonology Physician
Primary
N4322
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209230002
—
MO
Enumeration date
07/18/2006
Last updated
02/18/2019
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