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NPI Code Detail

MEDICARE: DR. RICHARD W. GANNON DO

MEDICARE: DR. RICHARD W. GANNON DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician02001IA

General Provider Information

NPI Number : 1881749018
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD W. GANNON DO
Provider Business Mailing Address
First Line : 5957 F48 WEST
Second Line :
City : NEWTON
State : IA
Zip : 50208
Country : US
Telephone Number : 641-792-4385
Fax Number :
Provider Business Practice Location Address
First Line : 800 S FILLMORE ST
Second Line :
City : OSCEOLA
State : IA
Zip : 50213-1619
Country : US
Telephone Number : 641-342-2184
Fax Number : 800-305-3233
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2007
Last Update Date : 07/08/2007

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