Healthcare Provider Details

I. General information

NPI: 1497870075
Provider Name (Legal Business Name): DAN W GANN MT(AAB),MLT(ASCP)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 W FRONT ST RTTEMPS
MEDIA PA
19063-2816
US

IV. Provider business mailing address

1514 VINYARD RD
MARSHFIELD MO
65706-9328
US

V. Phone/Fax

Practice location:
  • Phone: 800-677-8233
  • Fax:
Mailing address:
  • Phone: 417-830-8189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number2040004
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License NumberMLT19209
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: