Healthcare Provider Details

I. General information

NPI: 1295795318
Provider Name (Legal Business Name): JOSEPH EDWARD CANGAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N MAIN ST STE E
COLUMBIA IL
62236-1070
US

IV. Provider business mailing address

1550 N MAIN ST STE E
COLUMBIA IL
62236-1070
US

V. Phone/Fax

Practice location:
  • Phone: 618-281-4325
  • Fax: 618-281-8393
Mailing address:
  • Phone: 618-281-4325
  • Fax: 618-281-8393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2006007755
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036110913
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: