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General NPI Number Information
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NPI Number | 1538340039
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Entity Type | Organization
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Legal Business Name | GARDNER MEDICAL SURGICAL CONSULTANTS INC
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 3844 BRANTLEY PLACE CIR
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City | APOPKA
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State | FL
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Zip | 32703-6854
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Country | US
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Telephone | 407-733-5464
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Fax |
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Provider Business Mailing Address
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Address Line | 3844 BRANTLEY PLACE CIR
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City | APOPKA
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State | FL
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Zip | 32703-6854
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Country | US
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Telephone | 407-733-5464
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | MR. WAYNE M. GARDNER
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Credential | PA-C
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Telephone | 407-733-5464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA3289
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License Number State | FL
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