Individual
DR. GARY KANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1010 SPRUCE ST, ESPANOLA, NM 87532-2724
(505) 753-7111
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
4301112793
NM
207P00000X
Emergency Medicine Physician
Primary
MD2020-0828
NM
Other
Enumeration date
06/15/2017
Last updated
09/14/2020
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