Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 50010 | TN |
N | 2081P2900X | Pain Medicine | 22876 | MS |
N | 2081P2900X | Pain Medicine | 50010 | TN |
NPI | 1376569210 |
---|---|
Provider Name | Douglas Todd Cannon |
First Address | Germantown, TN 38138-2205 |
Second Address | Cordova, TN 38018-4227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 07/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05254852 | (05) | MS |
199076001 | (05) | AR |
Q004010 | (05) | TN |