Individual
DOMENIC MICHAEL CANONICO
Active
Individual
DOMENIC MICHAEL CANONICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
18819
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0192943
BCBS
TN
01
—
040013804
RAILROAD MEDICARE
TN
05
—
3085592
—
TN
Enumeration date
03/08/2006
Last updated
07/14/2015
Update your record
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