Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD00039610 | WA |
N | 2086X0206X | Surgical Oncologist | L9640 | TX |
NPI | 1013012608 |
---|---|
Provider Name | Christopher P. Cannon |
First Address | Seattle, WA 98104-1132 |
Second Address | Seattle, WA 98104-1132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 10/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
168579401 | (05) | TX |
H03618 | (02) |