Healthcare Provider Details

I. General information

NPI: 1932386315
Provider Name (Legal Business Name): CURTIS R. CANNING, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 RESEARCH PARK WAY SUITE 104
NORTH LOGAN UT
84341-1955
US

IV. Provider business mailing address

1750 N. RESEARCH PARK WAY SUITE 104
NORTH LOGAN UT
84341-6340
US

V. Phone/Fax

Practice location:
  • Phone: 435-753-0272
  • Fax: 435-753-2252
Mailing address:
  • Phone: 435-753-0272
  • Fax: 435-753-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number159037-1205
License Number StateUT

VIII. Authorized Official

Name: DR. CURTIS R CANNING
Title or Position: PRESIDENT
Credential: M.D.
Phone: 435-753-0272