MEDICARE: DR. RACHAEL MARIE CANNON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	161549	FL
2	208000000X	Pediatrics Physician	161549	FL
3	390200000X	Student in an Organized Health Care Education/Training Program	161549	FL

General Provider Information

NPI Number	:	1003444191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHAEL MARIE CANNON MD

Provider Business Mailing Address
First Line	:	3950 SW 24TH AVE APT 323
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-4470
Country	:	US
Telephone Number	:	814-574-2554
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 SW 24TH AVE APT 323
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-4470
Country	:	US
Telephone Number	:	352-273-8234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	10/23/2024

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