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NPI Code Detail

MEDICARE: SAMUEL T GARDNER III M.D.

MEDICARE: SAMUEL T GARDNER III M.D.
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
1207P00000XEmergency Medicine PhysicianL4386TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28G4159OTHERTXBCBSTX PROV NO

General Provider Information

NPI Number : 1801871538
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL T GARDNER III M.D.
Provider Business Mailing Address
First Line : PO BOX 200993
Second Line :
City : HOUSTON
State : TX
Zip : 77216-0993
Country : US
Telephone Number : 281-784-1111
Fax Number : 281-784-1555
Provider Business Practice Location Address
First Line : 12141 RICHMOND AVE
Second Line :
City : HOUSTON
State : TX
Zip : 77082-2408
Country : US
Telephone Number : 281-799-8600
Fax Number : 281-596-5947
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2005
Last Update Date : 12/27/2007

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