Provider Demographics
NPI:1629214242
Name:GARDINER, AUSTIN W (MD)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:W
Last Name:GARDINER
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 1:19355 MAIDSTONE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5505
Mailing Address - Country:US
Mailing Address - Phone:714-374-8475
Mailing Address - Fax:
Practice Address - Street 1:19355 MAIDSTONE LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5505
Practice Address - Country:US
Practice Address - Phone:714-374-8475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045685A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology