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General NPI Number Information
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NPI Number | 1285163246
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Entity Type | Individual
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Provider Name | MATTHEW MICHAEL GANNON MD
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Gender | Male
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 08/19/2021
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Provider Practice Location Address
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Address Line | 500 W THOMAS RD STE 600
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City | PHOENIX
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State | AZ
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Zip | 85013-4221
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Country | US
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Telephone | 602-406-4433
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Fax | 602-512-6545
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Provider Business Mailing Address
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Address Line | PO BOX 33269
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City | PHOENIX
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State | AZ
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Zip | 85067-3269
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Country | US
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Telephone | 602-406-4786
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Fax | 916-636-4358
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 60565
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R10852
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License Number State | IA
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