MEDICARE: GALE GARDNER, MD, PC

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	261QM2500X	Medical Specialty Clinic/Center	3843	TN

General Provider Information

NPI Number	:	1649461435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GALE GARDNER, MD, PC

Provider Business Mailing Address
First Line	:	1910 MADISON AVE
Second Line	:	PMB #620
City	:	MEMPHIS
State	:	TN
Zip	:	38104-2620
Country	:	US
Telephone Number	:	901-725-5167
Fax Number	:	901-725-7653

Provider Business Practice Location Address
First Line	:	1910 MADISON AVE
Second Line	:	PMB #620
City	:	MEMPHIS
State	:	TN
Zip	:	38104-2620
Country	:	US
Telephone Number	:	901-725-5167
Fax Number	:	901-725-7653

Authorized Official
Title or Position	:	SECRETARY/TREASURER
Name	:	MRS. CHARLOTTE GARDNER BURKE
Credential	:
Telephone Number	:	901-725-5167

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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