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Individual
DR. DAVID GANNON
Active
Individual
DR. DAVID GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
01311
MD
213E00000X
Podiatrist
E1-0000205
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3494004-00
—
MD
01
—
6031730002
DME
DE
01
—
E1-0000205
STATE LICENSE
DE
01
—
P00639639
RAIL ROAD MEDICARE - INDIVIDUAL PTAN
MD
Enumeration date
01/09/2006
Last updated
04/05/2019
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