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CHARLES CLIFFORD GARDNER M.D.

>> Surgery >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1396825980

Individual Registrant:
 CHARLES CLIFFORD GARDNER M.D.
Gender: M
Sole Proprietor

Location and contact information for practice:
3420 BUCKEYE RUN  FT WAYNE, IN 46814-8972 US
Tel: 260-444-4613  Fax: --

Contact information for business:
3420 BUCKEYE RUN  FT WAYNE, IN 46814-8972 US
Tel: 260-444-4613  Fax: --

Registration Information:
NPI: 1396825980
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N208600000XAllopathic & Osteopathic Physicians
Surgery
TXE6360
Y208C00000XAllopathic & Osteopathic Physicians
Colon & Rectal Surgery
OH35-049889

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
0675863OH05




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