Individual
DR. TIMOTHY GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
559 VINCENT ST BLDG 725, COLORADO SPRINGS, CO 80914-1541
(719) 556-7804
(719) 556-7399
Mailing address
3020 EBBTIDE VW, COLORADO SPRINGS, CO 80922-1272
(719) 493-2853
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0063682
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000346010
ANTHEM
OH
Enumeration date
10/05/2006
Last updated
01/22/2025
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