Michael P. Gardner, MD PC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

MD22270 Issued in OR

Legal business name

MICHAEL P. GARDNER, MD PC

Practice address

19260 SW 65TH Ave Ste 310
Tualatin, OR 97062-5710

Phone

(503) 692-1200

Fax

(503) 692-1220

NPI assigned

Nov 17, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shelly Banta

Title

Office Manager

Phone

(503) 783-0208

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Paul Gardner, M.D.

  • Urology Physician
  • Tualatin, OR
  • NPI 1215993845
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580256000000",
    "number": "1043684889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19260 SW 65TH AVE STE 310",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970625710",
            "telephone_number": "503-692-1200",
            "fax_number": "503-692-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19260 SW 65TH AVE STE 310",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970625710",
            "telephone_number": "503-692-1200",
            "fax_number": "503-692-1220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL P. GARDNER, MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-17",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A",
        "authorized_official_last_name": "BANTA",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-783-0208"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": "MD22270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "288387",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Meridian Park Radiation Oncolog Center, Inc
• Meridian Park Radiation Oncology Center, Inc.
• Samantha Merz
• Metatron Health LLC
• MFT Holdings, LLC
• Michael P. Gardner, MD PC
• Michael R Van Allen MD PC
• Michael W. Gehlen D.M.D.,P.C.
• Suzanne L Migchelbrink, MD
• Tatyana Mikhlina, LMT

• Clinic/Center in Tualatin, OR
• Providers in Tualatin, OR by specialty
• Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.