Individual
MR. CHARLES SANFORD GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1645 N. ALVERNON WAY #1, TUCSON, AZ 85712
(520) 881-7474
(520) 881-0676
Mailing address
1645 N. ALVERNON WAY #1, TUCSON, AZ 85712-3353
(520) 881-7474
(520) 881-0676
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
6156
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
221193
—
AZ
Enumeration date
08/16/2005
Last updated
05/03/2012
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