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NPI Code Detail

MEDICARE: JOHN C CANON MD

MEDICARE: JOHN C CANON 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 Physician27434NC
2207P00000XEmergency Medicine Physician27434NC

Other Identifiers

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

General Provider Information

NPI Number : 1699778639
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN C CANON MD
Provider Business Mailing Address
First Line : PO BOX 344
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27102-0344
Country : US
Telephone Number : 336-716-2255
Fax Number : 336-716-5438
Provider Business Practice Location Address
First Line : 1370 W D ST
Second Line :
City : NORTH WILKESBORO
State : NC
Zip : 28659-3506
Country : US
Telephone Number : 336-716-2255
Fax Number : 336-716-5438
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 09/27/2010

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