Provider Demographics
NPI:1124207527
Name:GANN, MARCUS LEON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:LEON
Last Name:GANN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:201 NW 15TH ST
Mailing Address - Street 2:PO BOX 69
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-1579
Mailing Address - Country:US
Mailing Address - Phone:785-263-0505
Mailing Address - Fax:785-263-0506
Practice Address - Street 1:201 NW 15TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-1579
Practice Address - Country:US
Practice Address - Phone:785-263-0505
Practice Address - Fax:785-263-0506
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-32823208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery