MEDICARE: FAY ALEXANDER CANNON JR. 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	174400000X	Specialist	ME95147	FL

General Provider Information

NPI Number	:	1932111374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAY ALEXANDER CANNON JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 428
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34656-0428
Country	:	US
Telephone Number	:	727-841-4200
Fax Number	:	727-841-4365

Provider Business Practice Location Address
First Line	:	8002 KING HELIE BLVD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-1435
Country	:	US
Telephone Number	:	727-841-4430
Fax Number	:

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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