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General NPI Number Information
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NPI Number | 1063415826
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Entity Type | Individual
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Provider Name | HAROLD C CANNON JR. MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 2200 E PARRISH AVE BLDG D SUITE 100
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City | OWENSBORO
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State | KY
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Zip | 42303-1449
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Country | US
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Telephone | 270-688-1770
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Fax | 270-688-1780
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Provider Business Mailing Address
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Address Line | 2200 E PARRISH AVE BLDG D SUITE 100
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City | OWENSBORO
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State | KY
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Zip | 42303-1449
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Country | US
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Telephone | 270-688-1770
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Fax | 270-688-1780
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 01036413A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 22288
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 22288
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License Number State | KY
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