River Valley Family Practice LTD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

RIVER VALLEY FAMILY PRACTICE LTD

Doing business as

David Gannon, MD

Practice address

2550 24TH St
Rock Island, IL 61201-5304

Phone

(309) 793-4223

Fax

(309) 793-6276

NPI assigned

Jan 22, 2007

Last updated

Oct 11, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Gannon, M.D.NPI 1003886128

Title

Doctor

Phone

(309) 739-4223

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• David Gannon, MD Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David L Gannon, M.D.

  • Family Medicine Physician
  • Rock Island, IL
  • NPI 1003886128
  Authorized official Same address or phone

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192060800000",
    "number": "1275687113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 35TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656145",
            "telephone_number": "309-736-4173",
            "fax_number": "309-797-5653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 24TH ST",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612015304",
            "telephone_number": "309-793-4223",
            "fax_number": "309-793-6276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER VALLEY FAMILY PRACTICE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-10-11",
        "status": "A",
        "authorized_official_last_name": "GANNON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "309-739-4223",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360532801",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "8132003",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "David Gannon, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anne Bronwen Richards, DDS
• Janna Elizabeth Richards, L.C.S.W.
• Angelica Richardson
• Frances Bernandine Ricketts, PHD
• Anthony T. Riordan, LMFT
• Kimberly Roark
• Robert W Milas MD SC
• Robert Young Center
• Patricia A Robinson, CRC, LBSW
• Rock Island Dental Associates LLP

• Family Medicine Physician in Rock Island, IL
• Providers in Rock Island, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; 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.