Healthcare Provider Details

I. General information

NPI: 1104124742
Provider Name (Legal Business Name): JOHN FRANK CANEDY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E SONTERRA BLVD STE 120
SAN ANTONIO TX
78258-4068
US

IV. Provider business mailing address

2700 W HIGGINS RD STE 120
HOFFMAN ESTATES IL
60169-2006
US

V. Phone/Fax

Practice location:
  • Phone: 210-494-1074
  • Fax: 210-494-1031
Mailing address:
  • Phone: 847-843-1900
  • Fax: 847-843-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: