PAUL CANNON PA NPI 1790212629

NPI Information

NPI: 1790212629
Provider Name: PAUL CANNON, PA
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

PECOS Registration: Yes

Address:
395 W COUGAR BLVD STE 503
PROVO, UT
ZIP 84604
Phone: (801) 442-3936
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Paul Cannon, PA is a surgical physician assistant in Provo, UT with 7 years of experience. Paul Cannon, PA NPI is 1790212629. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

395 W COUGAR BLVD STE 503
PROVO, UT
ZIP 84604-323
Phone: (801) 442-3936

The NPI 1790212629 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/23/2017 and was last updated on 8/16/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	PA.0005119	COLORADO	No
2	363AM0700X	Physician Assistant	Medical			No
3	363AS0400X	Physician Assistant	Surgical	12917809-1206	UTAH	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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