Healthcare Provider Details

I. General information

NPI: 1982605390
Provider Name (Legal Business Name): DAVID R. CANNON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 11/09/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 STATE ST NEW ALBANY
NEW ALBANY IN
47150-4929
US

IV. Provider business mailing address

1214 SPRING ST JEFFERSONVILLE
JEFFERSONVILLE IN
47130-3704
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-9141
  • Fax: 812-945-2252
Mailing address:
  • Phone: 812-283-5950
  • Fax: 812-285-5439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01023766A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: