Gwen R Cannon

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

831701581205 Issued in UT

Practice address

280 N Main St
Bountiful, UT 84010-6136

Phone

(801) 294-9933

NPI assigned

Aug 31, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347926400000",
    "number": "1770694309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-233-4400",
            "fax_number": "801-233-4410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 N MAIN ST",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840106136",
            "telephone_number": "801-294-9933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "GWEN",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2012-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "831701581205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Calvin Calvin
• Heather Gerschler Campagna
• Phillip Campbell
• Christopher Canale, MD
• Rebecca Canfield
• Hyrum M Cannon, DDS
• Canyon Ridge Chiropractic, Inc.
• Canyon Ridge Pain and Spine PC
• Lisa Cappelli
• Gina Markos Capps, CPNP

• Pediatrics Physician in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Pediatrics Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; 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.