Provider Demographics
NPI:1093911547
Name:D A GARDNER, DPM, PA
Entity Type:Organization
Organization Name:D A GARDNER, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-723-5400
Mailing Address - Street 1:1441 MIDLOTHIAN PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5591
Mailing Address - Country:US
Mailing Address - Phone:972-723-5400
Mailing Address - Fax:972-723-5401
Practice Address - Street 1:2203 WEST LAMPASAS
Practice Address - Street 2:SUITE 102
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119
Practice Address - Country:US
Practice Address - Phone:972-878-3400
Practice Address - Fax:972-878-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1433213ES0103X
TX1830213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z452Medicare PIN