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General NPI Number Information
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NPI Number | 1861487217
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Entity Type | Individual
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Provider Name | BRUCE W CANNON DO
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Gender | Male
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1710 HARPER RD
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City | BECKLEY
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State | WV
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Zip | 25801-3357
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Country | US
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Telephone | 800-277-8151
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Fax |
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Provider Business Mailing Address
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Address Line | L 2772
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City | COLUMBUS
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State | OH
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Zip | 43260-0001
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Country | US
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Telephone | 800-277-8151
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 1540
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 1540
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License Number State | WV
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