Individual
RICHARD CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2025 E 17TH ST, IDAHO FALLS, ID 83404-6430
(208) 524-2025
Mailing address
2025 E 17TH ST, IDAHO FALLS, ID 83404-6430
(208) 524-2025
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M-10001
ID
Other
Enumeration date
01/30/2007
Last updated
07/08/2007
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