Healthcare Provider Details

I. General information

NPI: 1790853091
Provider Name (Legal Business Name): LINDA J GARDINER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9771 CYPRESS LAKE DR
FORT MYERS FL
33919-6063
US

IV. Provider business mailing address

9771 CYPRESS LAKE DR
FORT MYERS FL
33919-6063
US

V. Phone/Fax

Practice location:
  • Phone: 239-565-9848
  • Fax:
Mailing address:
  • Phone: 239-565-9848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberME62716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: