Healthcare Provider Details

I. General information

NPI: 1144288952
Provider Name (Legal Business Name): CATHERINE L GARDNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S HICKORY ST HOLMES REGIONAL MEDICAL CENTER
MELBOURNE FL
32901-3224
US

IV. Provider business mailing address

PO BOX 561600
ROCKLEDGE FL
32956-1600
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-7313
  • Fax: 321-434-7238
Mailing address:
  • Phone: 321-434-4600
  • Fax: 321-434-4662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME67788
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: