Organization
LAWRENCE W GARDNER JR MD PA
Active
Organization
LAWRENCE W GARDNER JR MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE GARDNER M.D., F.A.C.G. (PRESIDENT)
(239) 574-8616
Entity
Organization
Contact information
Practice address
708 DEL PRADO BLVD, SUITE 5, CAPE CORAL, FL 33990-5616
(239) 574-8616
(239) 574-4451
Mailing address
708 DEL PRADO BLVD, SUITE 5, CAPE CORAL, FL 33990-5616
(239) 574-8616
(239) 574-4451
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME0034362
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038581-600
—
FL
01
—
1972653632
NPI
FL
01
—
79466
PTIN
FL
Enumeration date
11/11/2010
Last updated
05/12/2011
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