Healthcare Provider Details

I. General information

NPI: 1255334488
Provider Name (Legal Business Name): RONALD D GARDNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 WINKLER AVE UNIT 100
FORT MYERS FL
33916-9523
US

IV. Provider business mailing address

3033 WINKLER AVE UNIT 100
FORT MYERS FL
33916-9523
US

V. Phone/Fax

Practice location:
  • Phone: 239-277-7070
  • Fax: 239-277-7071
Mailing address:
  • Phone: 239-277-7070
  • Fax: 239-277-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0056224
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: