NPIMap

Organization Active NPI

Canon Professional, L.L.C.

  • Primary Care Clinic/Center
  • Canon City, CO
National Provider Identifier
1568625549
Registry record updated Jul 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
24731 Issued in CO
Legal business name
CANON PROFESSIONAL, L.L.C.
Practice address
730 Macon Ave
Canon City, CO 81212-3314
Phone
(719) 275-1618
Fax
(719) 275-7334
NPI assigned
Jul 9, 2008
Last updated
Jul 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2008

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

Authorized official

Name
Dr. Gary Alan Mohr, M.D.NPI 1659481836
Title
Owner
Phone
(719) 275-1618

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 24731 CO Primary

Addresses

Primary practice location

730 Macon Ave
Canon City, CO 81212-3314

Mailing address

730 Macon Ave
Canon City, CO 81212-3314
Phone (719) 275-1618

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215561600000",
    "number": "1568625549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 MACON AVE",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812123314",
            "telephone_number": "719-275-1618",
            "fax_number": "719-275-7334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 MACON AVE",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812123314",
            "telephone_number": "719-275-1618",
            "fax_number": "719-275-7334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANON PROFESSIONAL, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-09",
        "last_updated": "2008-07-09",
        "status": "A",
        "authorized_official_last_name": "MOHR",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-275-1618",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CO",
            "license": "24731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canon City, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.