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General NPI Number Information
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NPI Number | 1740285022
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Entity Type | Individual
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Provider Name | PAUL B CANNON DPM
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Gender | Male
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 104A E BROAD ST
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4501
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Country | US
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Telephone | 703-237-1555
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Fax | 703-237-2253
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Provider Business Mailing Address
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Address Line | 104A E BROAD ST
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4501
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Country | US
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Telephone | 703-237-1555
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Fax | 703-237-2253
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0103300931
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 01424
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO1000043
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State | IL
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