Provider Demographics
NPI:1497870075
Name:GANN, DAN W (MT(AAB),MLT(ASCP))
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:W
Last Name:GANN
Suffix:
Gender:M
Credentials:MT(AAB),MLT(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 VINYARD RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-9328
Mailing Address - Country:US
Mailing Address - Phone:417-830-8189
Mailing Address - Fax:
Practice Address - Street 1:9 W FRONT ST
Practice Address - Street 2:RTTEMPS
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2816
Practice Address - Country:US
Practice Address - Phone:800-677-8233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2040004246QM0706X
ILMLT19209246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Not Answered246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory