Individual
PAUL CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
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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