Active NPI
Max Kent Cannon, M.D.
- Surgery Physician
- Payson, UT
National Provider Identifier
1124036231
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(2) exclusion effective May 19, 2011.
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 97-347-228-1205
- Practice address
- 39 Professional Way
Suite 2
Payson, UT 84651-1675 - Phone
- (801) 465-1701
- Fax
- (801) 465-1707
- NPI assigned
- Aug 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 97-347-228-1205 | UT | Primary |
Addresses
Primary practice location
39 Professional Way
Suite 2
Payson, UT 84651-1675
Mailing address
PO Box 508
Payson, UT 84651-0508
Phone (801) 465-1701
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101271 | Other | UT | IHC-UT/ALL USA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 97-347-228-1205 | UT | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124036231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 508",
"city": "PAYSON",
"state": "UT",
"postal_code": "846510508",
"telephone_number": "801-465-1701",
"fax_number": "801-465-1707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "39 PROFESSIONAL WAY",
"address_2": "SUITE 2",
"city": "PAYSON",
"state": "UT",
"postal_code": "846511675",
"telephone_number": "801-465-1701",
"fax_number": "801-465-1707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "MAX",
"middle_name": "KENT",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "UT",
"license": "97-347-228-1205",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IHC-UT/ALL USA",
"identifier": "101271",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Payson, UT
- Kevin S Cahoon, DDS
- John Craig Callister, DMD
- John D Callister, D.D.S.
- Matthew S Callister, D.M.D.
- Larry David Campbell, SUDC
- Canyon View Medical Group LLC
- Canyon View Medical Group LLC
- Canyon View Medical Group LLC
- Canyonlands Health Care Special Service District
- Canyonlands Health Care Special Service District
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.