MEDICARE: DR. JACK DAVID GARDNER 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
1	2084N0400X	Neurology Physician	G3381	TX
2	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	G3381	TX

General Provider Information

NPI Number	:	1851383152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK DAVID GARDNER M.D.

Provider Business Mailing Address
First Line	:	1441 N BECKLEY AVE
Second Line	:	5TH FLOOR
City	:	DALLAS
State	:	TX
Zip	:	75203-1201
Country	:	US
Telephone Number	:	214-943-9300
Fax Number	:	214-942-3549

Provider Business Practice Location Address
First Line	:	1441 N BECKLEY AVE
Second Line	:	5TH FLOOR
City	:	DALLAS
State	:	TX
Zip	:	75203-1201
Country	:	US
Telephone Number	:	214-947-1837
Fax Number	:	214-942-3549

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	09/11/2025

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