Provider Demographics
NPI:1992790430
Name:CANNON, JOHN M (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:CANNON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1770 LONG POND RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-4057
Mailing Address - Country:US
Mailing Address - Phone:585-244-8110
Mailing Address - Fax:585-244-9435
Practice Address - Street 1:1770 LONG POND RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-4057
Practice Address - Country:US
Practice Address - Phone:585-244-8110
Practice Address - Fax:585-244-9435
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2008-08-21
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Provider Licenses
StateLicense IDTaxonomies
NY177388208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology