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NPI Code Detail

MEDICARE: DR. BRIAN SCOTT GANNON MD

MEDICARE: DR. BRIAN SCOTT GANNON 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
1208000000XPediatrics Physician40582KY
2208000000XPediatrics PhysicianMD30442TN
3208000000XPediatrics Physician32891AL

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 : 1912992678
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN SCOTT GANNON MD
Provider Business Mailing Address
First Line : 850 PETER BRYCE BLVD
Second Line :
City : TUSCALOOSA
State : AL
Zip : 35401-7419
Country : US
Telephone Number : 205-348-1304
Fax Number : 205-348-7988
Provider Business Practice Location Address
First Line : 850 PETER BRYCE BLVD
Second Line :
City : TUSCALOOSA
State : AL
Zip : 35401-7419
Country : US
Telephone Number : 205-348-1304
Fax Number : 205-348-7988
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2005
Last Update Date : 07/21/2022

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Directions to “ DR. BRIAN SCOTT GANNON MD” Practice Location

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