Provider Demographics
NPI:1255766127
Name:GARDNER, TROY ALLEN (CSA)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:ALLEN
Last Name:GARDNER
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16333 VANCE JACKSON APT 1127
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-5088
Mailing Address - Country:US
Mailing Address - Phone:210-760-9138
Mailing Address - Fax:830-772-5611
Practice Address - Street 1:16333 VANCE JACKSON APT 1127
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-5088
Practice Address - Country:US
Practice Address - Phone:210-760-9138
Practice Address - Fax:830-772-5611
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty