| Michael P. Gardner, Md Pc | |
|
19260 Sw 65th Ave Ste 310 Tualatin OR 97062-5710 | |
| (503) 692-1200 | |
| (503) 692-1220 |
| Full Name | Michael P. Gardner, Md Pc |
|---|---|
| Speciality | Clinic/center |
| Location | 19260 Sw 65th Ave Ste 310, Tualatin, Oregon |
| Authorized Official Name and Position | Shelly Banta (OFFICE MANAGER) |
| Authorized Official Contact | 5037830208 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael P. Gardner, Md Pc 19260 Sw 65th Ave Ste 310 Tualatin OR 97062-5710 Ph: (503) 692-1200 | Michael P. Gardner, Md Pc 19260 Sw 65th Ave Ste 310 Tualatin OR 97062-5710 Ph: (503) 692-1200 |
| NPI Number | 1043684889 |
|---|---|
| Provider Enumeration Date | 11/17/2015 |
| Last Update Date | 01/29/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043684889 | NPI | - | NPPES |
| 288387 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | MD22270 (Oregon) | Primary |
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