Provider Demographics
NPI:1275838542
Name:GARDERE, SERGE (DO)
Entity Type:Individual
Prefix:
First Name:SERGE
Middle Name:
Last Name:GARDERE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NE 26TH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1206
Mailing Address - Country:US
Mailing Address - Phone:954-381-7334
Mailing Address - Fax:888-809-1631
Practice Address - Street 1:1201 NE 26TH ST STE 109
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1206
Practice Address - Country:US
Practice Address - Phone:954-381-7334
Practice Address - Fax:888-809-1631
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11912204D00000X, 207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM