Cannon, Bryan James

Cannon, Bryan James is an individual health care provider with primary practice located at 16555 Manchester Rd Suite 100, Wildwood MO 63040-1220. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Cannon, Bryan James can be contacted via phone (636) 458-0646.

Contact Information

Primary practice address
16555 Manchester Rd Suite 100 Wildwood MO 63040-1220
Phone: (636) 458-0646
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 6038 Nebraska
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 2016016732 Missouri

Profile Details

NPI number 1265662068
LBN Legal business name Cannon, Bryan James
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 15th, 2009
Last updated Feb 8th, 2017 - about 9 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 1265662068 NPPES
Missouri MEDICAID 1265662068

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