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NPI Code Detail

MEDICARE: CANNON NELSON MD

MEDICARE: CANNON NELSON MD
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
1207Q00000XFamily Medicine Physician8628880-1205UT

General Provider Information

NPI Number : 1457000838
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANNON NELSON MD
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 354 W CROSSROADS BLVD
Second Line :
City : SARATOGA SPRINGS
State : UT
Zip : 84045-5506
Country : US
Telephone Number : 801-341-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2022
Last Update Date : 11/18/2025

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