Healthcare Provider Details

I. General information

NPI: 1487758843
Provider Name (Legal Business Name): CANTON PEDIATRICS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 S CENTRAL AVE SUITE A
PHOENIX AZ
85040-2148
US

IV. Provider business mailing address

4615 S CENTRAL AVE SUITE A
PHOENIX AZ
85040-2148
US

V. Phone/Fax

Practice location:
  • Phone: 602-232-2737
  • Fax: 602-232-2736
Mailing address:
  • Phone: 602-232-2737
  • Fax: 602-232-2736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LUCAS S CANTON
Title or Position: OWNER
Credential: M.D.
Phone: 602-232-2737