Individual
MICHAEL J GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2741 WHEATON WAY, BREMERTON, WA 98310-3344
(360) 782-1800
Mailing address
PO BOX 34581, SEATTLE, WA 98124-1581
(509) 241-7349
(509) 241-7628
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00034351
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8211765
—
WA
01
—
P00732101
MEDICARE RAILROAD
WA
Enumeration date
02/07/2007
Last updated
09/10/2009
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