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NPI Code Detail

MEDICARE: CAROL C GARDNER MD

MEDICARE: CAROL C GARDNER MD
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
1208M00000XHospitalist PhysicianME86611FL
2207RH0002XHospice and Palliative Medicine (Internal Medicine) PhysicianME86611FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629040597
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL C GARDNER MD
Provider Business Mailing Address
First Line : 2445 LANE PARK RD
Second Line :
City : TAVARES
State : FL
Zip : 32778-9648
Country : US
Telephone Number : 352-343-1341
Fax Number :
Provider Business Practice Location Address
First Line : 9400 TURKEY LAKE RD
Second Line :
City : ORLANDO
State : FL
Zip : 32819-8001
Country : US
Telephone Number : 407-351-8500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2006
Last Update Date : 01/16/2019

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