Provider Demographics
NPI:1003889619
Name:GARDNER, BRENDA S (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:S
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:S
Other - Last Name:GARDNER-CORTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4800 MEMORIAL DR BLDG 4
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76711-1329
Mailing Address - Country:US
Mailing Address - Phone:254-297-3000
Mailing Address - Fax:
Practice Address - Street 1:5283 OLD BROWNSVILLE RD
Practice Address - Street 2:.
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-3908
Practice Address - Country:US
Practice Address - Phone:361-806-5600
Practice Address - Fax:361-806-5601
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148208502Medicaid
TX8C2566Medicare ID - Type Unspecified