Individual
MICHAEL J GANNON
Active
Individual
MICHAEL J GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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