Individual
MR. JERMAINE CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1 MURPHY RD, WILMINGTON, DE 19803-3044
(302) 543-4004
Mailing address
24 NICOLE CT, NEW CASTLE, DE 19720-3762
(302) 377-5838
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT-0003237
DE
Other
Enumeration date
08/13/2020
Last updated
08/13/2020
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