MEDICARE: CYNTHIA DENISE GARDNER PA-C

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	363AM0700X	Medical Physician Assistant	PA01148	TX

General Provider Information

NPI Number	:	1851584742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA DENISE GARDNER PA-C

Provider Business Mailing Address
First Line	:	5625 EIGER RD
Second Line	:	SUITE 200
City	:	AUSTIN
State	:	TX
Zip	:	78735-8982
Country	:	US
Telephone Number	:	512-892-7076
Fax Number	:	512-892-1634

Provider Business Practice Location Address
First Line	:	5625 EIGER RD
Second Line	:	SUITE 200
City	:	AUSTIN
State	:	TX
Zip	:	78735-8982
Country	:	US
Telephone Number	:	512-892-7076
Fax Number	:	512-899-8460

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

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	05/26/2016

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