Tracy Fuchs Gannon, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

31837 Issued in MN

Practice address

3640 Talmage Circle
Suite 216
Vadnais Heights, MN 55110-4183

Phone

(651) 224-4930

Fax

(651) 842-3391

NPI assigned

Feb 21, 2006

Sex

Female

Sole proprietor

No

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Danielle Golden, Crna, PA

  • Adult Mental Health Clinic/Center
  • Vadnais Heights, MN
  • NPI 1598954687
  NPD (past)

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307059200000",
    "number": "1720053937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2854 HIGHWAY 55",
            "address_2": "SUITE 130",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551211447",
            "telephone_number": "651-224-4930",
            "fax_number": "651-842-3391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3640 TALMAGE CIRCLE",
            "address_2": "SUITE 216",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551104183",
            "telephone_number": "651-224-4930",
            "fax_number": "651-842-3391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "TRACY",
        "middle_name": "FUCHS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-21",
        "last_updated": "2011-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MN",
            "license": "31837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "947503600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bethann Marie Frazier, DNP, APRN FNP, PMHNP
• Lori A Fredericks, PT
• Morgan Alexandra Fricker, BA
• Meghan R Frink, PT
• James Gannon, MD
• Rachael C Gates
• Jennifer Ann Geske
• Ying Gibbens, MD PHD
• Nikki Gibbons, MA, LAMFT
• Philip Gerard Giesen, PT

• Dermatology Physician in Vadnais Heights, MN
• Providers in Vadnais Heights, MN by specialty
• Dermatology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2011; 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.