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Organization
TIMOTHY L. GARDNER, DPM,PC
Active
Organization
TIMOTHY L. GARDNER, DPM,PC
Active
Other names
Middlesboro Foot & Ankle Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY LOGAN GARDNER DPM (PODIATRIST)
(606) 248-2739
Entity
Organization
Contact information
Practice address
123 N 19TH ST, MIDDLESBORO, KY 40965-2865
(606) 248-2739
(606) 248-2730
Mailing address
10810 PARKSIDE DR STE 202, KNOXVILLE, TN 37934-1981
(865) 218-7474
(865) 218-7475
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
30924
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000053556
BCBS
KY
01
—
0191729
BCBS
TN
05
—
3351921
—
TN
05
—
80002017
—
KY
Enumeration date
08/13/2007
Last updated
10/17/2011
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