Healthcare Provider Details

I. General information

NPI: 1497997092
Provider Name (Legal Business Name): DANIEL EDWARD CANNON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 278
COEUR D ALENE ID
83814-4400
US

IV. Provider business mailing address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-5160
  • Fax: 208-625-5733
Mailing address:
  • Phone: 208-625-5085
  • Fax: 208-625-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberM14014
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: