Individual provider · Type 1 NPI

Jackson D. Gannon, PA-C

Surgical Physician Assistant · Omaha, NE

NPI number 1790357358 Active

Practice location

8200 Dodge St
Omaha, NE 68114-4113

Call (402) 955-8600 Map

Fax (402) 955-5905

Mailing address

PO Box 24607
Omaha, NE 68124-0607

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400X2632 (NE)

Surgical Physician Assistant: Definition to come...

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About NPI 1790357358

Jackson D. Gannon, PA-C's National Provider Identifier is 1790357358, issued on Jul 13, 2021. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Omaha, NE. The record was last updated on Jul 13, 2021.