Individual
PATRICK RUSSELL GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
20652
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0166707
UMWA
OK
05
—
1000176970A
—
OK
01
—
1324230001
PALMETTO DME
OK
01
—
731310891006
UNICARE
OK
01
—
731310891028
TRICARE SOUTH
OK
01
—
74502A024
CHAMPUS
OK
01
—
G67583
STERLING OPTION 1
OK
Enumeration date
04/06/2006
Last updated
01/29/2018
Update your record
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