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NPI Code Detail

MEDICARE: DR. EARL CANSON III M.D, MPH

MEDICARE: DR. EARL CANSON III M.D, MPH
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 PhysicianA119268CA

General Provider Information

NPI Number : 1609173996
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EARL CANSON III M.D, MPH
Provider Business Mailing Address
First Line : 450 E SPRING ST
Second Line : SUITE 1
City : LONG BEACH
State : CA
Zip : 90806-1625
Country : US
Telephone Number : 562-933-0063
Fax Number : 562-933-0079
Provider Business Practice Location Address
First Line : 3280 E FOOTHILL BLVD
Second Line :
City : PASADENA
State : CA
Zip : 91107-3148
Country : US
Telephone Number : 833-574-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2011
Last Update Date : 05/13/2026

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