Provider Demographics
NPI:1033282199
Name:GARDNER, BILLY FRANKLIN II (MD)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:FRANKLIN
Last Name:GARDNER
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:120 HEALTH PARK BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5798
Mailing Address - Country:US
Mailing Address - Phone:904-819-4400
Mailing Address - Fax:904-819-4472
Practice Address - Street 1:120 HEALTH PARK BLVD STE 1
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5798
Practice Address - Country:US
Practice Address - Phone:904-819-4400
Practice Address - Fax:904-819-4472
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030463207P00000X
FLME125043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA93BFBKDMedicare PIN