Provider Demographics
NPI:1003444191
Name:CANNON, RACHAEL MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:MARIE
Last Name:CANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10840 TOWN TER APT 203
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6543
Mailing Address - Country:US
Mailing Address - Phone:814-574-2554
Mailing Address - Fax:
Practice Address - Street 1:10840 TOWN TER APT 203
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33414-6543
Practice Address - Country:US
Practice Address - Phone:352-273-8234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL161549208000000X, 208M00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist