Provider Demographics
NPI:1083093991
Name:CANCIAN, JOHN WUNN SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WUNN
Last Name:CANCIAN
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:BUMED, CENTRALIZED CREDENTIAL AND PRIVILEGING DIRECTORA
Mailing Address - Street 2:554 KEILY STREET
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32212
Mailing Address - Country:US
Mailing Address - Phone:757-953-7550
Mailing Address - Fax:757-953-7560
Practice Address - Street 1:BUMED, CENTRALIZED CREDENTIAL AND PRIVILEGING DIRECTORA
Practice Address - Street 2:554 KEILY STREET
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212
Practice Address - Country:US
Practice Address - Phone:757-953-7550
Practice Address - Fax:757-953-7560
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2020-08-06
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Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101260832207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program