MEDICARE: DR. CRAIG FREDERICK CANNON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	93234	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013025568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG FREDERICK CANNON M.D.

Provider Business Mailing Address
First Line	:	4351 E LOHMAN AVE STE 201
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8260
Country	:	US
Telephone Number	:	575-522-2233
Fax Number	:	575-522-2266

Provider Business Practice Location Address
First Line	:	4351 E LOHMAN AVE STE 201
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8260
Country	:	US
Telephone Number	:	575-522-2233
Fax Number	:	575-522-2266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	09/08/2020

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Directions to “ DR. CRAIG FREDERICK CANNON M.D.” Practice Location

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