Provider Demographics
NPI:1184708968
Name:CANOVA, JOHN PETER (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PETER
Last Name:CANOVA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:678 PETALUMA AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4217
Mailing Address - Country:US
Mailing Address - Phone:707-829-2232
Mailing Address - Fax:707-829-9637
Practice Address - Street 1:678 PETALUMA AVE
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4217
Practice Address - Country:US
Practice Address - Phone:707-829-2232
Practice Address - Fax:707-829-3709
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-08-22
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Provider Licenses
StateLicense IDTaxonomies
CAG030459207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44432Medicare UPIN