Doctor Name: | WAYNE M GARDNER |
NPI Number: | 1134127590 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.A. |
License Number: | PA3289 |
Business Practice Address: | 3844 Brantley Place Cir Apopka, FL - 327036854 |
Business Phone Number: | 4077335464 |
Business Fax Number: | |
Mailing Address: | 3844 Brantley Place Cir, APOPKA |
State: | FL |
Postal Code: | 327036854 |
Phone Number: | 4077335464 |
Fax Number: | |
NPI Enumeration Date: | 07/11/2005 |
NPI Last Update Date: | 09/08/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | PA3289 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |