Cannon, Peter M
Cannon, Peter M is an sole proprietor health care provider with primary practice located at 2001 S Woodruff Ave Suite 4, Idaho Falls ID 83404-6374. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Cannon, Peter M can be contacted via phone (208) 524-4511.Contact Information
Primary practice address
2001 S Woodruff Ave Suite 4
Idaho Falls ID 83404-6374
Phone: (208) 524-4511
Fax: (208) 524-4540
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Urology | 208800000X | M-3494 | Idaho |
Profile Details
| NPI number | 1326032939 |
|---|---|
| LBN Legal business name | Cannon, Peter M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 9th, 2005 |
| Last updated | Apr 6th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1326032939 | NPPES |
| Idaho | MEDICAID | 002502000 |
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