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General NPI Number Information
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NPI Number | 1902095466
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Entity Type | Individual
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Provider Name | DEREK SLOANE CANNON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 1530 US HIGHWAY 43
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City | WINFIELD
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State | AL
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Zip | 35594-5056
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Country | US
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Telephone | 205-487-7000
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Fax | 877-915-6502
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Provider Business Mailing Address
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Address Line | 12370 ROAD 505
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City | PHILADELPHIA
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State | MS
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Zip | 39350-3364
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Country | US
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Telephone | 601-504-3170
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 30358
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 22691
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License Number State | MS
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