MEDICARE: DR. TIMOTHY LOGAN 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	DPM 409	TN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000053556	OTHER	KY	BCBS
4	0191729	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1841249224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY LOGAN GARDNER DPM

Provider Business Mailing Address
First Line	:	8930 CROSS PARK DR STE 2
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4713
Country	:	US
Telephone Number	:	865-269-2112
Fax Number	:	865-218-7475

Provider Business Practice Location Address
First Line	:	8930 CROSS PARK DR STE 2
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4713
Country	:	US
Telephone Number	:	865-218-7474
Fax Number	:	865-218-7475

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	04/26/2022

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