Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD.026402 | LA |
N | 208000000X | Pediatrician | MD.28842 | AL |
Y | 2080P0205X | Pediatric Endocrinologist | MD.026402 | LA |
NPI | 1487824637 |
---|---|
Provider Name | Dr. James Brewster Gardner JR. |
First Address | Baton Rouge, LA 70816-6038 |
Second Address | Baton Rouge, LA 70809-3481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2008 |
Last Update Date | 05/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07176038 | (05) | MS |
1062634 | (05) | LA |