Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | C1-0010871 | DE |
NPI | 1376754002 |
---|---|
Provider Name | Dr. Anthony W Gannon |
First Address | Wilmington, DE 19803-3607 |
Second Address | Wilmington, DE 19803-3607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 31/07/2015 |