Provider Demographics
NPI:1760771604
Name:GARDNER, JEFFREY THOMAS (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:THOMAS
Last Name:GARDNER
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 1:8102E MCDOWELL RD 2A
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3819
Mailing Address - Country:US
Mailing Address - Phone:480-272-8411
Mailing Address - Fax:480-361-1435
Practice Address - Street 1:8102E MCDOWELL RD 2A
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3819
Practice Address - Country:US
Practice Address - Phone:480-272-8411
Practice Address - Fax:480-361-1435
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006683207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology