Organization Name: | D A GARDNER, DPM, PA |
NPI Number: | 1093911547 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID A GARDNER (PRESIDENT) |
Mailing Address: | 2203 West Lampasas Suite 102 Ennis |
State: | TX US |
Postal Code: | 75119 |
Phone Number: | 9728783400 |
Fax Number: | 9728783401 |
NPI Enumeration Date: | 06/22/2007 |
NPI Last Update Date: | 09/24/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 1830 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |