Gannon, Patrick Russell

Gannon, Patrick Russell is an individual health care provider with primary practice located at 1 E Clark Bass Blvd Suite 210, Mcalester OK 74501-4209. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Gannon, Patrick Russell can be contacted via phone (918) 421-6987.

Contact Information

Primary practice address
1 E Clark Bass Blvd Suite 210 Mcalester OK 74501-4209
Phone: (918) 421-6987
Fax: (918) 421-6698
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 20652 Oklahoma

Profile Details

NPI number 1790747426
LBN Legal business name Gannon, Patrick Russell
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 6th, 2006
Last updated Jan 29th, 2018 - about 6 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790747426 NPPES
Oklahoma Other 74502A024 CHAMPUS
Oklahoma Other G67583 CHAMPUS
Oklahoma MEDICAID 1000176970A CHAMPUS
Oklahoma Other 731310891006 CHAMPUS
Oklahoma Other 1324230001 CHAMPUS
Oklahoma Other 731310891028 CHAMPUS
Oklahoma Other 0166707 CHAMPUS

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