Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A124399 | CA |
N | 208000000X | Pediatrician | Q0754 | TX |
Y | 2080P0204X | Pediatric Emergency Doctor | A124399 | CA |
NPI | 1205178712 |
---|---|
Provider Name | Dr. Michael Alexander Gardiner |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123-4223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2013 |
Last Update Date | 17/03/2018 |