Individual
DR. WAYNE H CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
389 S 900 E, SALT LAKE CITY, UT 84102-2310
(385) 282-2000
(385) 282-2001
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 519-7190
(801) 521-3091
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1665041205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
942854058520
—
UT
Enumeration date
06/06/2006
Last updated
04/17/2013
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