Individual
PAUL CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
395 W COUGAR BLVD STE 503, PROVO, UT 84604-3323
(801) 442-3936
Mailing address
395 W COUGAR BLVD STE 503, PROVO, UT 84604-3323
(801) 442-3936
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA.0005119
CO
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
12917809-1206
UT
Other
Enumeration date
05/23/2017
Last updated
08/16/2022
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