| Robert M Cannon Md Llc | |
|
1901 Mission 66 Vicksburg MS 39180-3711 | |
| (601) 636-0097 | |
| (601) 629-9969 |
| Full Name | Robert M Cannon Md Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1901 Mission 66, Vicksburg, Mississippi |
| Authorized Official Name and Position | Robert Cannon (MD) |
| Authorized Official Contact | 6016360097 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert M Cannon Md Llc 1901 Mission 66 Vicksburg MS 39180-3711 Ph: (601) 636-0097 | Robert M Cannon Md Llc 1901 Mission 66 Vicksburg MS 39180-3711 Ph: (601) 636-0097 |
| NPI Number | 1174067250 |
|---|---|
| Provider Enumeration Date | 12/08/2016 |
| Last Update Date | 12/08/2016 |
| Medicare PECOS PAC ID | 5890078067 |
|---|---|
| Medicare Enrollment ID | O20170214000363 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174067250 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Robert Cannon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215373139 PECOS PAC ID: 6305084427 Enrollment ID: I20170214000482 |
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