Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS11912 | FL |
Y | 207Q00000X | Family Doctor | OS11912 | FL |
NPI | 1275838542 |
---|---|
Provider Name | Serge Gardere |
First Address | Wilton Manors, FL 33305-1206 |
Second Address | Wilton Manors, FL 33305-1206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2011 |
Last Update Date | 17/07/2020 |