BRYAN JAMES CANNON (NPI# 1265662068) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265662068 |
| Entity Type | Individual |
| Full Name | BRYAN JAMES CANNON |
| Credential | MD |
| Practice Address |
16555 Manchester Rd Suite 100 Wildwood MO 63040-1220 |
| Practice Telephone | 6364580646 |
| Mailing Telephone | 6364580646 |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2017-02-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 2016016732 | MO | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 6038 | NE | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 1265662068 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942380373 | Bryan Cannon | Internal Medicine | 200 1st St Sw, Rochester, MN 55905-0001 | 2006-10-17 |
| Street Address |
16555 MANCHESTER RD SUITE 100 |
| City | WILDWOOD |
| State | MO |
| Zip Code | 63040-1220 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265405948 | Christie A Bayer | Pediatrics | 16555 Manchester Rd, Wildwood, MO 63040-1220 | 2006-02-11 |
| 1932572393 | Jenna Jordan | Registered Nurse | 16555 Manchester Rd, Suite 100, Wildwood, MO 63040-1220 | 2015-11-07 |
| 1477589422 | Michael Joseph Richardson | Family Medicine | 16555 Manchester Rd, Suite 100, Wildwood, MO 63040-1220 | 2006-06-23 |
| 1457307324 | Mary Patricia Tierney | Nurse Practitioner | 16555 Manchester Rd, Suite 110, Wildwood, MO 63040-1220 | 2006-05-25 |
| 1528034717 | Kent L Killian | Pediatrics | 16555 Manchester Rd, Suite 201, Wildwood, MO 63040-1220 | 2006-02-27 |
| 1164496725 | Michael J Carney | Pediatrics | 16555 Manchester Rd, Suite 201, Wildwood, MO 63040-1220 | 2006-02-13 |
| 1902870561 | Lisa C Burns | Family Medicine | 16555 Manchester Rd, Suite 100, Wildwood, MO 63040-1220 | 2006-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154959336 | Jacquelyn M Mellis | Social Worker | 2634 Hwy 109, Suite E, Wildwood, MO 63040 | 2020-04-01 |
| 1710359484 | Dierbergs Town Center Pharmacy | Pharmacy | 2460 Taylor Road, Wildwood, MO 63040 | 2015-10-21 |
| 1295175057 | Devin Willis | Family Medicine | 16555 Manchester Rd Ste 100, Wildwood, MO 63040 | 2013-06-26 |
| 1265748248 | Mary K Bland | Speech-Language Pathologist | 251 Plaza Dr, Wildwood, MO 63040 | 2010-08-27 |
| 1871726067 | Wildwood Internal Medicine, PC | Internal Medicine | 16759 Main Street, Suite 203, Wildwood, MO 63040 | 2009-09-03 |
| 1730274853 | Seth P Freedman | Dentist | 16920 Manchester Road, Wildwood, MO 63040 | 2006-10-04 |
| 1619332608 | Tonnya Marie Taggart | Nurse Practitioner | 16555 Manchester Rd Ste 110, Wildwood, MO 63040 | 2015-12-18 |
| 1477927556 | Forefront Dermatology, S.c. | Dermatology | 16516 Manchester Rd, Wildwood, MO 63040 | 2015-11-30 |
| 1881953784 | Glennia J Chitwood | Chiropractor | 16925 Manchester Rd, Suite 1, Wildwood, MO 63040 | 2012-05-11 |
| 1649363888 | Michael Paul Van Horenbeeck | Chiropractor | 16917 Manchester Rd, Wildwood, MO 63040 | 2006-10-02 |
| Find all providers in zip 63040 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801497953 | Wildwood Primary Care Associates | Family Medicine | 5814 Seven Mile Dr Ste 105, Wildwood, FL 34785-8869 | 2020-11-05 |
| 1760588768 | Brenda Gail Izen | Family Medicine | 2638 Highway 109 Ste 101, Wildwood, MO 63040-1161 | 2006-09-16 |
| 1285608745 | Richard Gary Olarsch | Family Medicine | 4211 Pacific Ave, Wildwood, NJ 08260-4622 | 2006-02-13 |
| 1851390322 | Jerrold Randall Ecklind | Family Medicine | 300 S Main St, Wildwood, FL 34785-4542 | 2005-07-18 |
| 1629565932 | Mid Florida Physicians Group Inc. | Family Medicine | 300 S Main St, Wildwood, FL 34785-4542 | 2018-04-23 |
| 1659531366 | Richard G. Olarsch, Do PC | Family Medicine | 4211 Pacific Ave, Wildwood, NJ 08260-4622 | 2008-06-16 |
| 1154508893 | Brenda G Izen M.d. PC | Family Medicine | 2638 Highway 109, Suite 101, Wildwood, MO 63040-1161 | 2008-01-24 |
| 1477589422 | Michael Joseph Richardson | Family Medicine | 16555 Manchester Rd, Suite 100, Wildwood, MO 63040-1220 | 2006-06-23 |
| 1902870561 | Lisa C Burns | Family Medicine | 16555 Manchester Rd, Suite 100, Wildwood, MO 63040-1220 | 2006-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811596877 | Stephanie R Nicholson | Family Medicine | 4500 S Park Ave, Sedalia, MO 65301-8525 | 2020-10-21 |
| 1053919514 | Kelli Lichte | Family Medicine | 601 S 13 Hwy, Lexington, MO 64067-1511 | 2020-10-15 |
| 1053927228 | Cox- Monett Hospital, Inc. | Family Medicine | 1000 E Hwy 60, Monett, MO 65708 | 2020-09-22 |
| 1104432806 | Jefferson Medical Group | Family Medicine | 807 E Broadway St, Brunswick, MO 65236-1468 | 2020-09-17 |
| 1124633995 | Continuum Family Care LLC | Family Medicine | 2336 S Main St, Maryville, MO 64468-3622 | 2020-09-09 |
| 1326652579 | Linda Diane Watson | Family Medicine | 338 Emerson Rd Apt 104, High Ridge, MO 63049-2530 | 2020-09-04 |
| 1447868005 | Brittany Mechelle Waterworth | Family Medicine | 3700 I 70 Dr Se Ste 106, Columbia, MO 65201-6587 | 2020-07-20 |
| 1013542828 | Johns Healthcare Services LLC | Family Medicine | 2001 Independence St Ste A, Cape Girardeau, MO 63703-5805 | 2020-03-12 |
| 1972133460 | Fnp4jc, LLC | Family Medicine | 215 North Street, Waynesville, MO 65583 | 2020-01-23 |
| 1568092732 | Scotland County Memorial Hospital | Family Medicine | 55682 State Highway 6, Edina, MO 63537-4267 | 2020-01-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.