Charles Sanford Gannon, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

6156 Issued in AZ

Practice address

1645 N. Alvernon Way #1
Tucson, AZ 85712

Phone

(520) 881-7474

Fax

(520) 881-0676

NPI assigned

Aug 16, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336003200000",
    "number": "1053303024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 N. ALVERNON WAY #1",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857123353",
            "telephone_number": "520-881-7474",
            "fax_number": "520-881-0676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 N. ALVERNON WAY #1",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85712",
            "telephone_number": "520-881-7474",
            "fax_number": "520-881-0676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "CHARLES",
        "middle_name": "SANFORD",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2012-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "AZ",
            "license": "6156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "221193",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabriela Ganddini-Wagner, M.D.
• Garima Gandotra, MD
• Marina Ganem, CNM
• Ashwin Venkataraman Ganesh, MD
• Amanda Ganey, PT, DPT
• Martha Ann Gans
• Dajanae Gant, LMT
• Mrinal Ganti
• Jessica Ganz, FNP
• Yohany Gaona-Rivas

• Ophthalmology Physician in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Ophthalmology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.