Bruce Gardner, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00020877 Issued in WA

Practice address

1915 Queen Anne Ave N
Seattle, WA 98109-2549

Phone

(206) 284-6132

Fax

(206) 284-2566

NPI assigned

Oct 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Queen Anne Family Medicine Inc PS

  • Family Medicine Physician
  • Seattle, WA
  • NPI 1679663967
  NPD (past) Authorized official

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

{
    "created_epoch": "1160870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1194815480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1915 QUEEN ANNE AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981092549",
            "telephone_number": "206-284-6132",
            "fax_number": "206-284-2566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 QUEEN ANNE AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981092549",
            "telephone_number": "206-284-6132",
            "fax_number": "206-284-2566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-15",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00020877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5350424",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8102048",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "GA5004",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julea Eve Gardener
• Laura Gardener, MA, LMHC
• Takla E Gardey, MD
• Nicole Elizabeth Gardiner, RDN
• Taylor Eliza Gardiner
• Clair Gardner
• Cole Gardner, DDS
• Jarreau E Gardner, MS, RD, CN
• Jennifer M Gardner, MD
• John F Gardner, AAC

• Family Medicine Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.