Healthcare Provider Details

I. General information

NPI: 1790965960
Provider Name (Legal Business Name): ALISON C GANONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10121 PINE AVE
TRUCKEE CA
96161-4856
US

IV. Provider business mailing address

PO BOX 759
TRUCKEE CA
96160-0759
US

V. Phone/Fax

Practice location:
  • Phone: 530-587-7461
  • Fax:
Mailing address:
  • Phone: 530-386-6965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number14820
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA101686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: