MEDICARE: TAMARA GARDUNO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD00037060	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0242680	OTHER	WA	DEPT OF LABOR AND INDUSTRIES
3	0242682	OTHER	WA	DEPT OF LABOR AND INDUSTRIES

General Provider Information

NPI Number	:	1063440766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA GARDUNO MD

Provider Business Mailing Address
First Line	:	PO BOX 3649
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99220-3649
Country	:	US
Telephone Number	:	509-838-2531
Fax Number	:

Provider Business Practice Location Address
First Line	:	3016 E 57TH AVE
Second Line	:	#24
City	:	SPOKANE
State	:	WA
Zip	:	99223-7036
Country	:	US
Telephone Number	:	509-838-2531
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	11/23/2011

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Directions to “ TAMARA GARDUNO MD” Practice Location

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