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:
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Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326032939 NPPES
Idaho MEDICAID 002502000

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