DR. ELIZABETH JOYCE GANNON (NPI# 1912268269) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912268269 |
| Entity Type | Individual |
| Full Name | DR. ELIZABETH JOYCE GANNON |
| Credential | D.O. |
| Practice Address |
3535 Southern Blvd Kettering OH 45429-1221 |
| Mailing Address |
3131 Newmark Dr Ste 220 Miamisburg OH 45342-5400 |
| Practice Telephone | 9373958166 |
| Mailing Telephone | 9374364658 |
| Mailing Fax Number | 9374364984 |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2020-05-05 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 34.011425 | OH | Allopathic & Osteopathic Physicians |
| N | 207P00000X | Emergency Medicine | OT014465 | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0119908 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 100 Kettering Way, Franklin, OH 450051155 | 9374584700 | |
| 1141 N Monroe Dr, Xenia, OH 453851619 | 9373522500 | |
| 1997 Miamisburg Centerville Rd, Centerville, OH 454593811 | 9374016228 | 9374016447 |
| 3535 Pentagon Blvd, Beavercreek, OH 454311705 | 9377024500 | |
| 4000 Miamisburg Centerville Rd, Miamisburg, OH 453427615 | 9373848791 | |
| 405 W Grand Ave, Dayton, OH 454057538 | 9377233211 | 9377234609 |
| 450 Washington Jackson Rd Ste F, Eaton, OH 453208699 | 9374568376 | 9374568377 |
| 600 W Main St, Troy, OH 453732928 | 9379807010 | 9379807019 |
| 6147 State Route 122, Middletown, OH 450055201 | 5132613410 | 5132613419 |
| 8701 Old Troy Pike, Huber Heights, OH 454241066 | 9375583338 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790926822 | Elizabeth Anne Gannon | Occupational Therapist | 204 Martin Rd, Lagrangeville, NY 12540-6348 | 2009-03-19 |
| 1942832076 | Elizabeth Gannon | Occupational Therapist | 567 N and South Rd Apt C, Saint Louis, MO 63130-3939 | 2020-02-06 |
| 1629397252 | Elizabeth Gannon | Speech-Language Pathologist | 915 10th Ave Nw, Ardmore, OK 73401-4025 | 2010-05-21 |
| 1205025905 | Elizabeth Claire Gannon | Physical Therapist | 1100 Blythe Blvd, Charlotte, NC 28203-5814 | 2007-10-18 |
| 1245433572 | Elizabeth Honore Gannon | Family Medicine | 1627 I St Nw Ste 800, Washington, DC 20006-4088 | 2007-06-06 |
| Street Address |
3535 SOUTHERN BLVD |
| City | KETTERING |
| State | OH |
| Zip Code | 45429-1221 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134124183 | David M Brouhard | Anesthesiology | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2005-06-16 |
| 1245846757 | Rachel Henderson | Pharmacist | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2020-09-21 |
| 1235745043 | Nipa Mukesh Patel | Pharmacist | 3535 Southern Blvd, Kettering, OH 45429-1298 | 2020-09-17 |
| 1104437425 | Stephanie Elizabeth Nicholls | Hospitalist | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2020-08-11 |
| 1346865144 | Anesthesia Pearls, LLC | Nurse Anesthetist, Certified Registered | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2020-06-08 |
| 1568087351 | Pearl Lee | Nurse Anesthetist, Certified Registered | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2020-06-08 |
| 1922631761 | Michael Patrick Lorey | Physician Assistant | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2020-02-20 |
| 1801446315 | Madison A Tate | Physician Assistant | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2019-09-17 |
| 1962058966 | Joshua Caleb Courlas | Physician Assistant | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2019-08-15 |
| 1134775273 | Jason Raymond Leigh | Physician Assistant | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2019-08-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821576414 | Lauren Danielle Sivley | Nurse Practitioner | 3535 Sourthern Boulevard, Kettering, OH 45429 | 2018-08-06 |
| 1114446127 | Louai Al-samkari | Chiropractor | 1441 E. Stroop Rd., Kettering, OH 45429 | 2017-09-12 |
| 1407373756 | Benjamin Edward Adkins | Specialist/Technologist | 4116 Vinita Dr., Kettering, OH 45429 | 2017-08-28 |
| 1972036341 | James Kim | Student in an Organized Health Care Education/Training Program | 3535 Southern Boulevard, Kettering, OH 45429 | 2017-04-04 |
| 1023549847 | Adrienne Krysiak | Emergency Medicine | 3525 Southern Boulevard, Kettering, OH 45429 | 2017-03-23 |
| 1386021889 | Cassandra Mckoy | Counselor | 529 East Stroop Road, Kettering, OH 45429 | 2015-05-04 |
| 1417343088 | Candace Benoit | Obstetrics & Gynecology | 3533 Southern Blvd Ste 4600, Dayton, OH 45429 | 2015-04-10 |
| 1275933574 | Lee Schwieterman | Nurse Practitioner | 3535 Southern Blvd., 1 East, Kettering, OH 45429 | 2014-08-25 |
| 1497161947 | Robert Jonathon Fresch Jr. | Obstetrics & Gynecology | 3533 Southern Blvd Ste 3750, Kettering, OH 45429 | 2014-07-05 |
| 1821349812 | Lucas Brewer | Counselor | 1524 E Stroop Rd Ste 300, Kettering, OH 45429 | 2012-10-01 |
| Find all providers in zip 45429 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023549847 | Adrienne Krysiak | Emergency Medicine | 3525 Southern Boulevard, Kettering, OH 45429 | 2017-03-23 |
| 1760466726 | Ryan Garner Mihata | Emergency Medicine | 3525 Southern Blvd, Wsu Em - Cox Building, Kettering, OH 45429-1221 | 2005-12-02 |
| 1609871458 | Gary E Gries | Emergency Medicine | 4750 Hempstead Station Dr, Kettering, OH 45429-5164 | 2005-06-17 |
| 1679079909 | Cole Little | Emergency Medicine | 3525 Southern Blvd, Kettering, OH 45429-1221 | 2018-04-04 |
| 1992230908 | Timothy Dekoninck | Emergency Medicine | 3525 Southern Blvd, 3525 Southern Blvd., Kettering, OH 45429-1221 | 2017-04-27 |
| 1790218535 | Daniel Shigley | Emergency Medicine | 3525 Southern Blvd, Kettering, OH 45429-1221 | 2017-04-08 |
| 1780117630 | Gregory Mark Gottschlich | Emergency Medicine | 3525 Southern Blvd, Kettering, OH 45429-1221 | 2017-04-07 |
| 1740637446 | John Mark Miller | Emergency Medicine | 3535 Southern Blvd, Kettering, OH 45429 | 2016-05-23 |
| 1841646064 | Jordan Jacobsen | Emergency Medicine | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2016-05-05 |
| 1902251796 | Nicholas Allen Elliott | Emergency Medicine | 3535 Southern Blvd, Kettering, OH 45429-1221 | 2016-04-28 |
| Find all providers in KETTERING | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.