Provider Demographics
NPI:1245259704
Name:CANN, ARTHUR (PHD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:
Last Name:CANN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 EGRET TRL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6263
Mailing Address - Country:US
Mailing Address - Phone:386-586-3969
Mailing Address - Fax:
Practice Address - Street 1:15 CYPRESS BRANCH WAY
Practice Address - Street 2:SUITE 207-C
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8413
Practice Address - Country:US
Practice Address - Phone:386-586-3969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6129103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54529Medicare ID - Type UnspecifiedIDENTIFICATION NUMBER