Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 0401006620 | VA |
NPI | 1104896398 |
---|---|
Provider Name | Dr. Thomas Joseph Canaan |
First Address | Jacksonville, FL 32214-5005 |
Second Address | Jacksonville, FL 32214-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 08/07/2007 |