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NPI Code Detail

MEDICARE: DAVID E GANNETT JR. MD

MEDICARE: DAVID E GANNETT JR. MD
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
12085R0001XRadiation Oncology PhysicianMD20984OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467454165
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID E GANNETT JR. MD
Provider Business Mailing Address
First Line : 847 NE 19TH AVE
Second Line : SUITE 300
City : PORTLAND
State : OR
Zip : 97232-2684
Country : US
Telephone Number : 503-963-2801
Fax Number : 503-963-2825
Provider Business Practice Location Address
First Line : 9205 SW BARNES RD
Second Line :
City : PORTLAND
State : OR
Zip : 97225-6603
Country : US
Telephone Number : 503-216-2195
Fax Number : 503-216-2196
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 09/16/2013

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