Healthcare Provider Details

I. General information

NPI: 1982166344
Provider Name (Legal Business Name): DAVID C CANTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90089-1001
US

IV. Provider business mailing address

636 N GARDNER ST
LOS ANGELES CA
90036-5711
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-7053
  • Fax:
Mailing address:
  • Phone: 850-766-6653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA177658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: