Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 07635 | MS |
NPI | 1437269479 |
---|---|
Provider Name | Dr. Charles Ron Cannon |
First Address | Jackson, MS 39296 |
Second Address | Flowood, MS 39232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 24/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08553384 | (05) | MS |
D74322 | (02) |