NPI 1043684889

Michael P. Gardner, MD PC

Organisation Clinic/Center Tualatin, OR

Practice location

Address: 19260 SW 65th Ave STE 310, Tualatin, OR 97062-5710
Phone: (503) 692-1200
Fax: (503) 692-1220

Authorised official

Name: Shelly Banta
Title: Office Manager
Phone: (503) 783-0208

Registered specialties

Clinic/Center Primary

Ambulatory Health Care Facilities Taxonomy 261Q00000X Licence MD22270 (OR)

Other Clinic/Center providers in Oregon →

Registry record

NPI: 1043684889
Entity type: Organization
NPI issued: 17 Nov 2015
Record last updated: 29 Jan 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.