Individual
DR. PAUL R GANNINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1585 WOODLAKE DR, SUITE 100, CHESTERFIELD, MO 63017-5740
(314) 434-4278
(314) 851-4466
Mailing address
PO BOX 23340, SAINT LOUIS, MO 63156-3340
(314) 434-4278
(314) 851-4466
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2003003397
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209094002
—
MO
Enumeration date
03/29/2006
Last updated
02/18/2015
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