Healthcare Provider Details

I. General information

NPI: 1972544583
Provider Name (Legal Business Name): DAVID ADRIAN CANCELADA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W 8TH ST
ONAGA KS
66521-9574
US

IV. Provider business mailing address

120 W 8TH ST
ONAGA KS
66521-9574
US

V. Phone/Fax

Practice location:
  • Phone: 785-889-4274
  • Fax: 785-889-4749
Mailing address:
  • Phone: 785-889-4274
  • Fax: 785-889-4749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberR5P90
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number04-31386
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: