Provider Demographics
NPI:1891677159
Name:CANNON, CHRISTOPHER ANWAR
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ANWAR
Last Name:CANNON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S FORT THOMAS AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2241
Mailing Address - Country:US
Mailing Address - Phone:859-443-5262
Mailing Address - Fax:
Practice Address - Street 1:660 S FORT THOMAS AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-4220
Practice Address - Country:US
Practice Address - Phone:859-443-5262
Practice Address - Fax:859-443-5262
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program