Provider Demographics
NPI:1932386315
Name:CURTIS R. CANNING, MD, PC
Entity Type:Organization
Organization Name:CURTIS R. CANNING, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:CANNING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-753-0272
Mailing Address - Street 1:1750 N. RESEARCH PARK WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-6340
Mailing Address - Country:US
Mailing Address - Phone:435-753-0272
Mailing Address - Fax:435-753-2252
Practice Address - Street 1:1750 RESEARCH PARK WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1955
Practice Address - Country:US
Practice Address - Phone:435-753-0272
Practice Address - Fax:435-753-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT159037-1205261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
C63602Medicare UPIN
UT000010354Medicare PIN