Individual
GWEN R CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
280 N MAIN ST, BOUNTIFUL, UT 84010-6136
(801) 294-9933
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 233-4400
(801) 233-4410
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
831701581205
UT
Other
Enumeration date
08/31/2006
Last updated
09/18/2012
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