Provider Demographics
NPI:1801009089
Name:GARDNER, JAMES ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ERIC
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38238
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-0238
Mailing Address - Country:US
Mailing Address - Phone:901-861-8088
Mailing Address - Fax:901-861-8082
Practice Address - Street 1:1750 MADISON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6492
Practice Address - Country:US
Practice Address - Phone:901-861-8088
Practice Address - Fax:901-861-8082
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN354172086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00463969OtherRAILROAD
TN5442058Medicaid
MS00120944Medicaid
TN3000895Medicare PIN
MS00120944Medicaid