Provider Demographics
NPI:1194774646
Name:CANNADAY, JERRY (DO)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:CANNADAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CORDOBA CENTER DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71909-4030
Mailing Address - Country:US
Mailing Address - Phone:501-915-0837
Mailing Address - Fax:501-915-0978
Practice Address - Street 1:121 CORDOBA CENTER DR
Practice Address - Street 2:SUITE 400
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71909-4030
Practice Address - Country:US
Practice Address - Phone:501-915-0837
Practice Address - Fax:501-915-0978
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7542207Q00000X
ARR-4722208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84Z865OtherBCBS
TX1341125-04Medicaid
TX080095891OtherRR MEDICARE
TX080095891OtherRR MEDICARE
TX84Z865OtherBCBS
TX1341125-04Medicaid