| Lawrence W Gardner Jr Md Pa | |
|
708 Del Prado Blvd Suite 5 Cape Coral FL 33990-5616 | |
| (239) 574-8616 | |
| (239) 574-4451 |
| Full Name | Lawrence W Gardner Jr Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 708 Del Prado Blvd, Cape Coral, Florida |
| Authorized Official Name and Position | Lawrence Gardner (PRESIDENT) |
| Authorized Official Contact | 2395748616 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lawrence W Gardner Jr Md Pa 708 Del Prado Blvd Suite 5 Cape Coral FL 33990-5616 Ph: (239) 574-8616 | Lawrence W Gardner Jr Md Pa 708 Del Prado Blvd Suite 5 Cape Coral FL 33990-5616 Ph: (239) 574-8616 |
| NPI Number | 1194026849 |
|---|---|
| Provider Enumeration Date | 11/11/2010 |
| Last Update Date | 05/12/2011 |
| Medicare PECOS PAC ID | 1951587666 |
|---|---|
| Medicare Enrollment ID | O20110513000556 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194026849 | NPI | - | NPPES |
| 038581-600 | Medicaid | FL | |
| 1972653632 | Other | FL | NPI |
| 79466 | Other | FL | PTIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | ME0034362 (Florida) | Primary |
| Provider Name | Lawrence W Gardner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972653632 PECOS PAC ID: 4688850308 Enrollment ID: I20110513000573 |
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