Gary W Fannon (NPI# 1447512819, PAC ID# 1759537202) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1447512819 |
| PAC ID by PECOS | 1759537202 |
| Professional Enrollment ID | I20120815000813 |
| Full Name | Gary W Fannon |
| Organization Legal Name | LEGACY PHYSICIAN GROUP, P.C. |
| Address |
1540 Lake Lansing Rd Suite 203 Lansing MI 48912-3757 |
| Phone Number | 5179136711 |
| Gender | M |
| Graduation Year | 2012 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 0648277830 |
| Number of Group Practice Members | 8 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 1540 Lake Lansing Rd, Suite 203, Lansing, MI 48912-3757 | 5179136711 | LEGACY PHYSICIAN GROUP, P.C. |
| Organization Legal Name | LEGACY PHYSICIAN GROUP, P.C. |
| Physicians | 12 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Brian S Nao | Internal Medicine | Legacy Physician Group, P.C. | 1540 Lake Lansing Rd, Suite 203, Lansing, MI 48912-3757 |
| James M Diekema | Physician Assistant | Legacy Physician Group, P.C. | 1540 Lake Lansing Rd, Suite 203, Lansing, MI 48912-3757 |
| Laurie C Wallace | Emergency Medicine | Legacy Physician Group, P.C. | 1540 Lake Lansing Rd, Suite 203, Lansing, MI 48912-3757 |
| Holly Christine Cook | Physician Assistant | Legacy Physician Group, P.C. | 1540 Lake Lansing Rd, Suite 203, Lansing, MI 48912-3757 |
| Susan Therese Fedewa | Emergency Medicine | Legacy Physician Group, P.C. | 1540 Lake Lansing Rd, Suite 203, Lansing, MI 48912-3757 |
| Kourtney Elaine Finnerty | Nurse Practitioner | Legacy Physician Group, P.C. | 1540 Lake Lansing Rd, Suite 203, Lansing, MI 48912-3757 |
| Tarah J Rakoski | Physician Assistant | Legacy Physician Group, P.C. | 1540 Lake Lansing Rd, Suite 203, Lansing, MI 48912-3757 |
| Robert K Orr Jr. | Emergency Medicine | Legacy Physician Group, P.C. | 1540 Lake Lansing Rd, Suite 203, Lansing, MI 48912-3757 |
| Daniel L Richardson | Emergency Medicine | Legacy Physician Group, P.C. | 1540 Lake Lansing Rd, Suite 203, Lansing, MI 48912-3757 |
| Patricia Jean Nakfoor | Emergency Medicine | Legacy Physician Group, P.C. | 1540 Lake Lansing Rd, Suite 203, Lansing, MI 48912-3757 |
| Street Address |
1540 LAKE LANSING RD SUITE 203 |
| City | LANSING |
| State | MI |
| Zip | 48912-3757 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Nicole M Milliken | Nurse Practitioner | Anesthesia and Pain Management | 1540 Lake Lansing Rd, G06, Lansing, MI 48912-3756 |
| Upendra M Shah | Obstetrics/gynecology | Mclaren Greater Lansing | 1540 Lake Lansing Rd, Suite 204, Lansing, MI 48912-3757 |
| Rehana Qadir | Internal Medicine | Mclaren Greater Lansing | 1540 Lake Lansing Rd, Suite 201, Lansing, MI 48912-3757 |
| Grace Escamilla | Internal Medicine | Mclaren Greater Lansing | 1540 Lake Lansing Rd, Suite 201, Lansing, MI 48912-3757 |
| Nicholas J St Hilaire | General Surgery | Mclaren Greater Lansing | 1540 Lake Lansing Rd, Suite 104, Lansing, MI 48912-3757 |
| Malani Gupta | Anesthesiology | Anesthesia and Pain Management | 1540 Lake Lansing Rd, G06, Lansing, MI 48912-3756 |
| Brian S Nao | Internal Medicine | Legacy Physician Group, P.C. | 1540 Lake Lansing Rd, Suite 203, Lansing, MI 48912-3757 |
| Kevin D Orr | Anesthesiology | Anesthesia and Pain Management | 1540 Lake Lansing Rd, G06, Lansing, MI 48912-3756 |
| Stephanie Baukus | Internal Medicine | Mclaren Greater Lansing | 1540 Lake Lansing Rd, Suite 201, Lansing, MI 48912-3757 |
| Lindsey Jenks | Nurse Practitioner | Mclaren Greater Lansing | 1540 Lake Lansing Rd, Suite 102, Lansing, MI 48912-3757 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Lynn P Nevin | Family Practice | Edward W Sparrow Hospital Association | 430 N Larch St B, Lansing, MI 48912-1208 |
| Daniel J Triezenberg | Family Medicine | Edward W Sparrow Hospital Association | 430 N Larch St, Suite B, Lansing, MI 48912-1266 |
| Lauren C Allswede | Clinical Social Worker | 119 Pere Marquette Dr, Suite 2d, Lansing, MI 48912-1270 | |
| Jennifer Lynn Edgar | Nurse Practitioner | County of Ingham | 1115 S Pennsylvania Ave, River Oak Community Health Center, Lansing, MI 48912-1671 |
| Narasimha R Gundamraj | Anesthesiology | Anesthesia and Pain Management | 1200 E Michigan Ave Lower Level, Lansing, MI 48912-1800 |
| Christopher Thomas Huhta | Pulmonary Disease | Compass Healthcare Plc | 1200 E Michigan Ave, Sparrow Hospital, Lansing, MI 48912-1800 |
| Andrew M Duda | Thoracic Surgery | Edward W Sparrow Hospital Association | 1200 E Michigan Ave, Suite 325, Lansing, MI 48912-1800 |
| Angela C Griffin | Obstetrics/gynecology | Edward W Sparrow Hospital Association | 1200 E Michigan Ave, Suite 325, Lansing, MI 48912-1800 |
| Elizabeth A Hamber | Anesthesiology | Anesthesia and Pain Management | 1200 E Michigan Ave Lower Level, Lansing, MI 48912-1800 |
| Sankar A Nair | Anesthesiology | Anesthesia and Pain Management | 1200 E Michigan Ave Lower Level, Lansing, MI 48912-1800 |
| Find all physicians in zip 48912 | |||
| City | LANSING |
| Zip Code | 48912 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | LANSING + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Gary W Fannon.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.