MEDICARE: PATRICIA GARDNER 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	2084P0800X	Psychiatry Physician	MD00040428	WA
2	2084P0800X	Psychiatry Physician	MD17033	OR

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

General Provider Information

NPI Number	:	1326114760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA GARDNER MD

Provider Business Mailing Address
First Line	:	3034 NE MLK JR BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-3053
Country	:	US
Telephone Number	:	503-936-5542
Fax Number	:	503-735-0912

Provider Business Practice Location Address
First Line	:	3034 NE MLK JR BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-3053
Country	:	US
Telephone Number	:	503-936-5542
Fax Number	:	503-735-0912

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	11/04/2020

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