Provider Demographics
NPI:1578516746
Name:GARDNER, ALBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:E
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 SE OSCEOLA ST.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994
Mailing Address - Country:US
Mailing Address - Phone:772-286-0078
Mailing Address - Fax:772-286-2288
Practice Address - Street 1:725 SE OSCEOLA ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-286-0078
Practice Address - Fax:772-286-2288
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0015899207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39289OtherBLUE CROSS/ BLUE SHIELD
FL31079OtherBCBS OF FLORIDA
FL038306600Medicaid
FL31079ZMedicare PIN
FL31079OtherBCBS OF FLORIDA