MEDICARE: DAVE GARDNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	7227	CA

General Provider Information

NPI Number	:	1245577246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVE GARDNER

Provider Business Mailing Address
First Line	:	1517 FARMERS LN
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-7525
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1517 FARMERS LN
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-7525
Country	:	US
Telephone Number	:	707-959-4333
Fax Number	:	707-595-4350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2013
Last Update Date	:	01/10/2013

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