Provider Demographics
NPI:1972653632
Name:GARDNER, LAWRENCE W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:W
Last Name:GARDNER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:708 DEL PRADO BLVD
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-5616
Mailing Address - Country:US
Mailing Address - Phone:239-574-8616
Mailing Address - Fax:239-574-4451
Practice Address - Street 1:708 DEL PRADO BLVD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-5616
Practice Address - Country:US
Practice Address - Phone:239-574-8616
Practice Address - Fax:239-574-4451
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 0034362207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD67299Medicare UPIN
FL79466Medicare ID - Type Unspecified