Provider Demographics
NPI:1578569620
Name:CANALE, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:CANALE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4132 KEATON CROSSING BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8222
Mailing Address - Country:US
Mailing Address - Phone:636-244-3589
Mailing Address - Fax:636-244-3594
Practice Address - Street 1:4132 KEATON CROSSING BLVD
Practice Address - Street 2:STE 201
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8222
Practice Address - Country:US
Practice Address - Phone:636-244-3589
Practice Address - Fax:636-244-3594
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR4A132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
102831OtherHEALTHLINK
8358OtherBLUE CROSS BLUE SHIELD
8358OtherBLUE CROSS BLUE SHIELD
A10137Medicare UPIN