Individual
TRACY FUCHS GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3640 TALMAGE CIRCLE, SUITE 216, VADNAIS HEIGHTS, MN 55110-4183
(651) 224-4930
(651) 842-3391
Mailing address
2854 HIGHWAY 55, SUITE 130, EAGAN, MN 55121-1447
(651) 224-4930
(651) 842-3391
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
31837
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
947503600
—
MN
Enumeration date
02/21/2006
Last updated
06/03/2011
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