Healthcare Provider Details

I. General information

NPI: 1063588200
Provider Name (Legal Business Name): JEFFREY TODD GARDNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEFFREY TODD GARDNER M.D.

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W FIR AVE #101
CLOVIS CA
93611-0223
US

IV. Provider business mailing address

PO BOX 28949
FRESNO CA
93729-8949
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-7294
  • Fax: 559-299-0641
Mailing address:
  • Phone: 559-228-4200
  • Fax: 559-224-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA 64748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: