Healthcare Provider Details

I. General information

NPI: 1891905642
Provider Name (Legal Business Name): ISLAND ORTHOPEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9154 ESTATE THOMAS LOWER LEVEL
ST THOMAS VI
00802-2687
US

IV. Provider business mailing address

PO BOX 503030
ST THOMAS VI
00805-3030
US

V. Phone/Fax

Practice location:
  • Phone: 340-714-5400
  • Fax:
Mailing address:
  • Phone: 340-714-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1376
License Number StateVI

VIII. Authorized Official

Name: DR. JULIA C GARDNER
Title or Position: OWNER
Credential: MD
Phone: 340-714-5400