Healthcare Provider Details

I. General information

NPI: 1164489191
Provider Name (Legal Business Name): O BOYD GARDO JR. ANAPLASTOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 N FANT ST
ANDERSON SC
29621-5707
US

IV. Provider business mailing address

126 COOL MEADOWS DR
PIEDMONT SC
29673-8941
US

V. Phone/Fax

Practice location:
  • Phone: 864-226-3006
  • Fax: 864-845-5034
Mailing address:
  • Phone: 864-226-3006
  • Fax: 864-845-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: