Individual
DR. JOE M. GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
607 RUE DE BRILLE, NEW IBERIA, LA 70563-2169
(337) 367-1247
(337) 365-7496
Mailing address
124 KAROLWOOD DR, LAFAYETTE, LA 70503-3505
(225) 718-3764
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
10553R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1655091
—
LA
Enumeration date
06/14/2005
Last updated
05/12/2021
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