Provider Demographics
NPI:1306813571
Name:FANNING, JOHN W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:FANNING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9828 E SHANNON WOODS CIR # 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4100
Mailing Address - Country:US
Mailing Address - Phone:316-631-1600
Mailing Address - Fax:316-631-1617
Practice Address - Street 1:9828 E SHANNON WOODS CIR # 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4100
Practice Address - Country:US
Practice Address - Phone:316-631-1600
Practice Address - Fax:316-631-1617
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-22803207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100165590DMedicaid
KS101521Medicare ID - Type Unspecified