Domenic Michael Canonico
Plastic Surgeon (Head & Neck)
507 Nw Atlantic St
Tullahoma
, Tennessee 37388-3504
Domenic Michael Canonico
Plastic Surgeon (Head & Neck)
507 Nw Atlantic St
Tullahoma
, Tennessee 37388-3504
(931) 393-2304
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About
Features
Specialties
- Plastic Surgeon (Head & Neck)
Languages spoken
- English
Location
First Address
- Domenic Michael Canonico
- 507 Nw Atlantic St
- Tullahoma, TN
- Zip : 37388-3504
- Fax : (931) 393-2304
- Phone : (931) 393-4332
Second Address
- Domenic Michael Canonico
- 507 Nw Atlantic St
- Tullahoma, TN
- Zip : 37388-3504
- Fax : (931) 393-2304
- Phone : (931) 393-4332
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 18819 | TN |
National Provider Identifier
| NPI | 1770551640 |
|---|---|
| Provider Name | Domenic Michael Canonico |
| First Address | Tullahoma, TN 37388-3504 |
| Second Address | Tullahoma, TN 37388-3504 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 08/03/2006 |
| Last Update Date | 14/07/2015 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 0192943 | BCBS (01) | TN |
| 040013804 | RAILROAD MEDICARE (01) | TN |
| 3085592 | (05) | TN |
| F89263 | (02) | TN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.