Individual
DR. CARRIE ATWELL GANONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3001 DAGGETT AVE, KLAMATH FALLS, OR 97601-1114
(541) 851-4800
(541) 851-4801
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(605) 328-6585
(605) 328-6512
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
44131
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01325653
—
CO
05
—
64958960
—
KY
Enumeration date
06/27/2007
Last updated
04/19/2013
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