Healthcare Provider Details

I. General information

NPI: 1427209857
Provider Name (Legal Business Name): ANDREW DAVID GARDNER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24375 FM 1314 RD
PORTER TX
77365-4205
US

IV. Provider business mailing address

24375 FM 1314 RD PO BOX 734
PORTER TX
77365-4205
US

V. Phone/Fax

Practice location:
  • Phone: 281-354-5663
  • Fax: 281-354-1995
Mailing address:
  • Phone: 281-354-5663
  • Fax: 281-354-1995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: