Individual
DR. JEFFREY R. CANHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
302 W HAY ST, SUITE 200, DECATUR, IL 62526-4167
(217) 877-8925
(217) 877-0020
Mailing address
4431 COUNTRY MANOR CT, DECATUR, IL 62521-2520
(217) 422-8300
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036-060206
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036060206
—
IL
Enumeration date
07/19/2005
Last updated
08/20/2014
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