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General NPI Number Information
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NPI Number | 1962786517
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Entity Type | Organization
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Legal Business Name | ANDREW CANNON, M.D., A MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/30/2011
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 215 W JANSS RD
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1847
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Country | US
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Telephone | 805-578-8300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10076
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City | VAN NUYS
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State | CA
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Zip | 91410-0076
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Country | US
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Telephone | 805-578-8300
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Fax | 805-578-3911
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW CANNON
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Credential | M.D.
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Telephone | 805-578-8300
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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 | A112567
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License Number State | CA
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