Healthcare Provider Details

I. General information

NPI: 1609173996
Provider Name (Legal Business Name): EARL CANSON III M.D, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 E FOOTHILL BLVD
PASADENA CA
91107-3148
US

IV. Provider business mailing address

450 E SPRING ST SUITE 1
LONG BEACH CA
90806-1625
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone: 562-933-0063
  • Fax: 562-933-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA119268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: