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NPI Code Detail

MEDICARE: CANTON PEDIATRICS P.C.

MEDICARE: CANTON PEDIATRICS P.C.
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
1208000000XPediatrics Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1826688OTHERAZAHCCCS

General Provider Information

NPI Number : 1487758843
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANTON PEDIATRICS P.C.
Provider Business Mailing Address
First Line : 4615 S CENTRAL AVE
Second Line : SUITE A
City : PHOENIX
State : AZ
Zip : 85040-2148
Country : US
Telephone Number : 602-232-2737
Fax Number : 602-232-2736
Provider Business Practice Location Address
First Line : 4615 S CENTRAL AVE
Second Line : SUITE A
City : PHOENIX
State : AZ
Zip : 85040-2148
Country : US
Telephone Number : 602-232-2737
Fax Number : 602-232-2736
Authorized Official
Title or Position : OWNER
Name : DR. LUCAS S CANTON
Credential : M.D.
Telephone Number : 602-232-2737
Provider Enumeration Date : 09/07/2006
Last Update Date : 10/18/2012

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Directions to “CANTON PEDIATRICS P.C. ” Practice Location

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