Organization Name: | RODDY A. GARDNER, D.O. P.C. |
NPI Number: | 1073796223 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RODDY A. GARDNER (PRESIDENT) |
Mailing Address: | 910 S Priest Dr Tempe |
State: | AZ US |
Postal Code: | 852815233 |
Phone Number: | 4809677821 |
Fax Number: | 4809671247 |
NPI Enumeration Date: | 12/11/2007 |
NPI Last Update Date: | 02/14/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 975 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |