Provider Demographics
NPI:1427209857
Name:GARDNER, ANDREW DAVID (PA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAVID
Last Name:GARDNER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24375 FM 1314 RD
Mailing Address - Street 2:PO BOX 734
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-4205
Mailing Address - Country:US
Mailing Address - Phone:281-354-5663
Mailing Address - Fax:281-354-1995
Practice Address - Street 1:24375 FM 1314 RD
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-4205
Practice Address - Country:US
Practice Address - Phone:281-354-5663
Practice Address - Fax:281-354-1995
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical