Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 16546 | AL |
NPI | 1124056957 |
---|---|
Provider Name | Dr. Debra Gardner |
First Address | Mobile, AL 36608-2201 |
Second Address | Mobile, AL 36606-4062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 19/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F31395 | (02) | AL |