Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 22288 | KY |
NPI | 1063415826 |
---|---|
Provider Name | Mr. Harold C Cannon JR. |
First Address | Owensboro, KY 42303-1449 |
Second Address | Owensboro, KY 42303-1449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 08/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000388450 | ANTHEM (01) | KY |
100015240A | (05) | IN |
64222888 | (05) | KY |
C67955 | (02) |