Provider Demographics
NPI:1891974333
Name:ROBERT A. GARDNER, MD, PA
Entity Type:Organization
Organization Name:ROBERT A. GARDNER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:AUBREY
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-881-9100
Mailing Address - Street 1:2151 45TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2026
Mailing Address - Country:US
Mailing Address - Phone:561-881-9100
Mailing Address - Fax:561-881-9277
Practice Address - Street 1:2151 45TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2026
Practice Address - Country:US
Practice Address - Phone:561-881-9100
Practice Address - Fax:561-881-9277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0015070174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40095Medicare PIN