MEDICARE: HONOR CANON 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	208000000X	Pediatrics Physician	M6065	TX

General Provider Information

NPI Number	:	1043210347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HONOR CANON MD

Provider Business Mailing Address
First Line	:	PO BOX 26726
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78755-0726
Country	:	US
Telephone Number	:	512-407-8686
Fax Number	:

Provider Business Practice Location Address
First Line	:	3816 S 1ST ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-7048
Country	:	US
Telephone Number	:	512-443-1311
Fax Number	:	512-448-8250

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	10/31/2007

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Directions to “ HONOR CANON MD” Practice Location

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