Provider Demographics
NPI:1659616787
Name:GARDNER, TOMMY L (BS, BIOCHEMISTRY)
Entity Type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:L
Last Name:GARDNER
Suffix:
Gender:M
Credentials:BS, BIOCHEMISTRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N GUADALUPE ST # 469
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1868
Mailing Address - Country:US
Mailing Address - Phone:505-919-8819
Mailing Address - Fax:
Practice Address - Street 1:54 AVENIDA ALDEA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-9449
Practice Address - Country:US
Practice Address - Phone:505-919-8819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMEXEMPT175L00000X
246ZB0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZB0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiochemist
No175L00000XOther Service ProvidersHomeopath