Provider Demographics
NPI:1932307378
Name:MCGANN, DESIREE JACQUELINE (DPM)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:JACQUELINE
Last Name:MCGANN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-0636
Mailing Address - Country:US
Mailing Address - Phone:256-259-3668
Mailing Address - Fax:888-381-8569
Practice Address - Street 1:319 PARKS AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2411
Practice Address - Country:US
Practice Address - Phone:256-259-3668
Practice Address - Fax:888-381-8569
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL197213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051546443OtherBCBS OF AL PIN
AL510I480007Medicare PIN
ALU61635Medicare UPIN