MEDICARE: DR. DAVID G GARDNER DPM

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	213E00000X	Podiatrist	PD221R	LA

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	:	1811965916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID G GARDNER DPM

Provider Business Mailing Address
First Line	:	3101 KILPATRICK BLVD
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-5157
Country	:	US
Telephone Number	:	318-322-5506
Fax Number	:	318-322-5916

Provider Business Practice Location Address
First Line	:	3101 KILPATRICK BLVD
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-5157
Country	:	US
Telephone Number	:	318-322-5506
Fax Number	:	318-322-5916

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	06/29/2010

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