Provider Demographics
NPI:1982737292
Name:DONNA H. CANNEY, MD, PHD, P.A.
Entity Type:Organization
Organization Name:DONNA H. CANNEY, MD, PHD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:HILL
Authorized Official - Last Name:CANNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:936-825-1721
Mailing Address - Street 1:PO BOX 1461
Mailing Address - Street 2:
Mailing Address - City:NAVASOTA
Mailing Address - State:TX
Mailing Address - Zip Code:77868-1461
Mailing Address - Country:US
Mailing Address - Phone:936-825-1721
Mailing Address - Fax:
Practice Address - Street 1:222 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868-3028
Practice Address - Country:US
Practice Address - Phone:936-825-1721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DONNA H. CANNEY, MD, PHD, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-14
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1439531-01Medicaid
TX00277QMedicare PIN
TX1439531-01Medicaid