| Organization Name: | TIMOTHY L. GARDNER, DPM,PC |
| NPI Number: | 1225220379 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIMOTHY LOGAN GARDNER (PODIATRIST) |
| Mailing Address: | 123 N 19th St Middlesboro |
| State: | KY US |
| Postal Code: | 409652865 |
| Phone Number: | 6062482739 |
| Fax Number: | 6062482730 |
| NPI Enumeration Date: | 08/13/2007 |
| NPI Last Update Date: | 10/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 30924 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |