Gannon, Tim B
Gannon, Tim B is an individual health care provider with primary practice located at 3450 Zafarano Dr Suite C, Santa Fe NM 87507-2669. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Gannon, Tim B can be contacted via phone (505) 466-5885.Contact Information
Primary practice address
3450 Zafarano Dr Suite C
Santa Fe NM 87507-2669
Phone: (505) 466-5885
Fax: (505) 466-5886
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA2010-0058 | New Mexico |
Profile Details
| NPI number | 1780992024 |
|---|---|
| LBN Legal business name | Gannon, Tim B |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 21st, 2010 |
| Last updated | Oct 8th, 2013 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780992024 | NPPES |
| New Mexico | MEDICAID | 25773119 |
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