MEDICARE: GARDNER FAMILY CARE

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1780906578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDNER FAMILY CARE

Provider Business Mailing Address
First Line	:	514 DANIELS ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27605-1317
Country	:	US
Telephone Number	:	919-677-7879
Fax Number	:

Provider Business Practice Location Address
First Line	:	514 DANIELS ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27605-1317
Country	:	US
Telephone Number	:	919-677-7879
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD DAILEY
Credential	:
Telephone Number	:	919-677-7879

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	02/19/2010

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