Provider Demographics
NPI:1639674047
Name:GARDNER, JACOB STERLING (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:STERLING
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 1:3333 CATTLEMEN RD STE 208
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6058
Mailing Address - Country:US
Mailing Address - Phone:941-379-5121
Mailing Address - Fax:941-379-4239
Practice Address - Street 1:3333 CATTLEMEN RD STE 208
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6058
Practice Address - Country:US
Practice Address - Phone:941-379-5121
Practice Address - Fax:941-379-4239
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME149653207R00000X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program