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General NPI Number Information
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NPI Number | 1194774646
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Entity Type | Individual
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Provider Name | JERRY CANNADAY DO
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 121 CORDOBA CENTER DR SUITE 400
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City | HOT SPRINGS
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State | AR
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Zip | 71909-4030
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Country | US
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Telephone | 501-915-0837
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Fax | 501-915-0978
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Provider Business Mailing Address
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Address Line | 121 CORDOBA CENTER DR SUITE 400
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City | HOT SPRINGS
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State | AR
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Zip | 71909-4030
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Country | US
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Telephone | 501-915-0837
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Fax | 501-915-0978
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D7542
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | R-4722
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R-4722
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License Number State | AR
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