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General NPI Number Information
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NPI Number | 1851383152
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Entity Type | Individual
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Provider Name | JACK DAVID GARDNER M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1441 N BECKLEY AVE 5TH FLOOR
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City | DALLAS
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State | TX
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Zip | 75203-1201
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Country | US
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Telephone | 214-947-1837
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Fax | 214-942-3549
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Provider Business Mailing Address
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Address Line | 1441 N BECKLEY AVE 5TH FLOOR
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City | DALLAS
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State | TX
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Zip | 75203-1201
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Country | US
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Telephone | 214-943-9300
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Fax | 214-942-3549
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | G3381
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number | G3381
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License Number State | TX
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