Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Gary Fannon, PA

Individual provider Medical Physician Assistant · NPI 1447512819

Gary Fannon, PA is a Physician Assistant in Flint, Michigan. Qualified in 2012, 14 years ago. Practices with Legacy Physician Group PC, an 11-clinician group and accepts Medicare assignment.

Years since qualifying
14
In the registry since
2012
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1 Hurley Plz
Flint, MI 48503-5902
Phone: (810) 262-9683
Fax: (810) 760-0440
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X

Record details

NPI number1447512819
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedJune 12, 2012
Last updated in NPPESJune 12, 2012

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Legacy Physician Group Pc — 11 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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