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Individual

DR. KATHLEEN RITA GANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
1810 SW WHITE BIRCH CIRCLE, STE 111, ANKENY, IA 50023-7226
(515) 964-7115
(515) 964-7899
Mailing address
6800 LAKE DRIVE, STE 250, WEST DES MOINES, IA 50266-2504
(515) 875-9925
(515) 875-9923

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
03077
IA
207R00000X
Internal Medicine Physician
T2006-010
AR
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
03077
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
159949003
AR
05
9170589
IA
Enumeration date
05/03/2006
Last updated
07/11/2011
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