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General NPI Number Information
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NPI Number | 1386018141
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Entity Type | Individual
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Provider Name | ROBERT GANNON
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Gender | Male
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Dates
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Enumeration Date | 11/17/2015
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 1689 SEBRING HILLS DR
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City | HENDERSON
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State | NV
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Zip | 89052-6930
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Country | US
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Telephone | 702-703-9163
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Fax | 702-897-7554
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Provider Business Mailing Address
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Address Line | PO BOX 778060
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City | HENDERSON
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State | NV
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Zip | 89077-8060
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Country | US
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Telephone | 702-703-9163
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Fax | 702-897-7554
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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