Provider Demographics
NPI:1174616619
Name:GARDNER, DONALD F (MD)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:F
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 BUSINESS CENTER DR
Mailing Address - Street 2:STE 550
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2737
Mailing Address - Country:US
Mailing Address - Phone:713-984-8200
Mailing Address - Fax:713-984-1113
Practice Address - Street 1:1140 BUSINESS CENTER DR
Practice Address - Street 2:STE 550
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-2737
Practice Address - Country:US
Practice Address - Phone:713-984-8200
Practice Address - Fax:713-984-1113
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5909174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760191917OtherTAX ID
TX114356202Medicaid
TX00QG37OtherBCBS
TX1043401193OtherGROUP
TX1174616619OtherBCBS
TX1043401193OtherGROUP
TX00QG37Medicare PIN
TX1174616619OtherBCBS