person
Tim B Gannon, PA
Medical Physician Assistant in Santa Fe, New Mexico
NPI 1780992024

Tim B Gannon is a Medical Physician Assistant based in Santa Fe, NM and is specialized in Medical. Tim B Gannon practices in Santa Fe, NM and has the professional credentials of PA. The NPI Number for Tim B Gannon is 1780992024 and holds a License No. PA2010-0058 (New Mexico).

The current practice location address for Tim B Gannon is 3450 Zafarano Dr, Santa Fe, NM and can be reached out via phone at 505-466-5885 and via fax at 505-466-5886.

Location: 3450 Zafarano Dr, Santa Fe, NM, 87507-2669
person
Provider Profile Details
NPI Number
1780992024
Provider Name
Tim B Gannon
Credential
PA
Provider Entity Type
Individual
Gender
Male
Address
3450 Zafarano Dr, Santa Fe, NM, 87507-2669
Phone Number
505-466-5885
Fax Number
505-466-5886
Provider Enumeration Date
09/21/2010
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
25773119 05 NM
institution
Provider Business Practice Location Address Details
Address
3450 Zafarano Dr
City
State
Zip
87507-2669
Phone Number
505-466-5885
Fax Number
505-466-5886
person
Provider Business Mailing Address Details
Address
3450 Zafarano Dr
City
State
Zip
87507-2669
Phone Number
505-466-5885
Fax Number
505-466-5886
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
PA2010-0058 (New Mexico)
Definition
Definition to come...
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