Provider Demographics
NPI:1871590794
Name:CANNON, ODEST FRANK JR (MD)
Entity type:Individual
Prefix:DR
First Name:ODEST
Middle Name:FRANK
Last Name:CANNON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 SE 17TH ST
Mailing Address - Street 2:#100
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-3968
Mailing Address - Country:US
Mailing Address - Phone:352-351-3422
Mailing Address - Fax:352-351-9129
Practice Address - Street 1:1015 SE 17TH ST
Practice Address - Street 2:#100
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-3968
Practice Address - Country:US
Practice Address - Phone:352-351-3422
Practice Address - Fax:352-351-9129
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052187207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069474600Medicaid
FLD21193Medicare UPIN
FL0294090001Medicare NSC
FL069474600Medicaid