Organization
MICHAEL P. GARDNER, MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY BANTA (OFFICE MANAGER)
(503) 783-0208
Entity
Organization
Contact information
Practice address
19260 SW 65TH AVE STE 310, TUALATIN, OR 97062-5710
(503) 692-1200
(503) 692-1220
Mailing address
19260 SW 65TH AVE STE 310, TUALATIN, OR 97062-5710
(503) 692-1200
(503) 692-1220
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
MD22270
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288387
—
OR
Enumeration date
11/17/2015
Last updated
01/29/2020
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