Provider Demographics
NPI:1790282218
Name:CANNON, MADISON DUCKWORTH (MD)
Entity Type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:DUCKWORTH
Last Name:CANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MADISON
Other - Middle Name:DUCKWORTH
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:209 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-3447
Mailing Address - Country:US
Mailing Address - Phone:432-758-4750
Mailing Address - Fax:866-751-0864
Practice Address - Street 1:209 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3447
Practice Address - Country:US
Practice Address - Phone:432-758-4799
Practice Address - Fax:866-751-0864
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT0438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine