NPIMap

Organization Active NPI

Cannon Family Medicine LLC

  • Family Medicine Physician
  • Crowley, LA
National Provider Identifier
1043372089
Registry record updated Mar 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
025690 Issued in LA
Legal business name
CANNON FAMILY MEDICINE LLC
Practice address
719 N Eastern Ave
Crowley, LA 70526-3856
Phone
(337) 783-5900
Fax
(337) 783-5914
NPI assigned
Dec 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stephen R Cannon, MD
Title
Owner
Phone
(337) 783-5900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 025690 LA Primary

Addresses

Primary practice location

719 N Eastern Ave
Crowley, LA 70526-3856

Mailing address

719 N Eastern Ave
Crowley, LA 70526-3856
Phone (337) 783-5900

Other identifiers 1

IdentifierTypeStateIssuer
1048577MedicaidLA

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206316800000",
    "number": "1043372089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 N EASTERN AVE",
            "city": "CROWLEY",
            "state": "LA",
            "postal_code": "705263856",
            "telephone_number": "337-783-5900",
            "fax_number": "337-783-5914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 N EASTERN AVE",
            "city": "CROWLEY",
            "state": "LA",
            "postal_code": "705263856",
            "telephone_number": "337-783-5900",
            "fax_number": "337-783-5914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANNON FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2008-03-24",
        "status": "A",
        "authorized_official_last_name": "CANNON",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-783-5900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "025690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1048577",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crowley, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.