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NPI Code Detail

MEDICARE: MR. GARTH MCKEAN CANNON PA-C

MEDICARE: MR. GARTH MCKEAN CANNON PA-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
1363A00000XPhysician Assistant5384822-1206UT

General Provider Information

NPI Number : 1942209440
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GARTH MCKEAN CANNON PA-C
Provider Business Mailing Address
First Line : 1912 W 930 N
Second Line :
City : PLEASANT GROVE
State : UT
Zip : 84062-4104
Country : US
Telephone Number : 801-492-1999
Fax Number :
Provider Business Practice Location Address
First Line : 1912 W 930 N
Second Line :
City : PLEASANT GROVE
State : UT
Zip : 84062-4104
Country : US
Telephone Number : 801-492-1999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 01/16/2015

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