Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 6358 | MT |
NPI | 1285616169 |
---|---|
Provider Name | Daniel M Gannon |
First Address | Bozeman, MT 59715-8812 |
Second Address | Bozeman, MT 59715-8812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22139 | (05) | MT |
D97875 | (02) | MT |