Provider Demographics
NPI:1669401709
Name:GANNUCH, DARREN PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:DARREN
Middle Name:PAUL
Last Name:GANNUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6805 GREENHILL BLVD NW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-8325
Mailing Address - Country:US
Mailing Address - Phone:256-505-6826
Mailing Address - Fax:256-571-2862
Practice Address - Street 1:380 WOODS COVE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2428
Practice Address - Country:US
Practice Address - Phone:256-505-6826
Practice Address - Fax:256-571-2862
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL443032084P0800X
AL20632084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL331300551Medicaid
AL15-09393OtherUNITED BEHAVIORAL HEALTH
AL331334651Medicaid
AL15-19393OtherUNITED BEHAVIORAL HEALTH
AL51536196OtherBLUE CROSS BLUE SHIELD
AL009938031Medicaid
AL15-19393OtherUNITED BEHAVIORAL HEALTH
ALG29403Medicare UPIN
AL009938031Medicaid