Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 04-27839 | KS |
NPI | 1225037732 |
---|---|
Provider Name | Joseph V. Cannova JR. |
First Address | Leawood, KS 66211-1454 |
Second Address | Leawood, KS 66211-1454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G14640 | (02) |