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Organization

MICHAEL P. GARDNER, MD PC

Active
Other names
Oregon Urology Alliance
Organization subpart
No

Provider details

NPI number
Authorized official
SHELLY BANTA (OFFICE MANAGER)
(503) 334-5958
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
208800000X
Urology Physician
Primary
MD22270
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
288387
OMAP NUMBER
05
288387
OR
Enumeration date
11/23/2007
Last updated
01/08/2024
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