Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Paul Cannon, PA

Individual provider Medical Physician Assistant · NPI 1790212629

Paul Cannon, PA is a Physician Assistant in Provo, Utah. Qualified in 2017, 9 years ago. Practices with Ihc Health Services Inc, a 3,947-clinician group and accepts Medicare assignment. Licensed in Colorado and Utah.

Years since qualifying
9
Licensed in
CO, UT
In the registry since
2017
Specialties on file
3
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

395 W Cougar Blvd Ste 503
Provo, UT 84604-3323
Phone: (801) 442-3936
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 12917809-1206 (UT)
Medical Physician Assistant Taxonomy 363AM0700X · Licence PA.0005119 (CO)
Medical Physician Assistant Taxonomy 363AM0700X

Record details

NPI number1790212629
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedMay 23, 2017
Last updated in NPPESAugust 16, 2022
Certification dateAugust 16, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Ihc Health Services Inc — 3947 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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