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John C Canon

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NPI Number Detailed Information

Provider Information:

Name: John C Canon
Gender: M
Provider License Number If Given: 27434

NPI Information:

NPI: 1699778639
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 5/23/2005

Last Update Date: 9/27/2010

Provider Business Mailing Address:

Address: PO BOX 344
Winston Salem, NC 27102
Phone Number: 3367162255
Fax Number: 3367165438

Provider Business Practice Location Address:

Address: 1370 W D ST
North Wilkesboro, NC 28659
Phone Number: 3367162255
Fax Number: 3367165438

Provider Taxonomy:

Primary: 207P00000X
Secondary (if any): 207Q00000X
State: NC

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