Healthcare Provider Details

I. General information

NPI: 1447424908
Provider Name (Legal Business Name): GERALD L TARDER, MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LA CASA VIA B2 107
WALNUT CREEK CA
94598
US

IV. Provider business mailing address

130 LA CASA VIA B2 107
WALNUT CREEK CA
94598
US

V. Phone/Fax

Practice location:
  • Phone: 925-938-6060
  • Fax: 925-938-0119
Mailing address:
  • Phone: 925-938-6060
  • Fax: 925-938-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: GERALD L TARDER
Title or Position: OWNER
Credential: MD
Phone: 925-938-6060