Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | AFE18697 | CA |
NPI | 1033528351 |
---|---|
Provider Name | Robert Darrell Cannon |
First Address | Walnut Creek, CA 94595-3195 |
Second Address | Walnut Creek, CA 94595-3195 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2014 |
Last Update Date | 12/08/2014 |