Jerry D. Gardner, M.D

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD009630E Issued in PA

Practice address

75 Desilva Island Drive
Mill Valley, CA 94941

Phone

(415) 381-1041

Fax

(415) 381-1046

NPI assigned

Jan 13, 2011

Last updated

Jan 13, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1294876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294876800000",
    "number": "1396040838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 DESILVA ISLAND DRIVE",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "94941",
            "telephone_number": "415-381-1041",
            "fax_number": "415-381-1046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 DESILVA ISLAND DRIVE",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "94941",
            "telephone_number": "415-381-1041",
            "fax_number": "415-381-1046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "JERRY",
        "middle_name": "D.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-01-13",
        "last_updated": "2011-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD009630E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bronni Galin, M.F.C.
• Sarah Deanna Garayalde, DO
• Gabriela Garcia-Rojas, D.D.S.
• John Garcia, MD
• Richard John Garcia, DDS
• Sarah Garlick, LCSW
• Gary Birnbaum MD Prof Corp
• Gary R Nelson DDS MSD Inc
• Claude Paul Genain, MD
• Daniel Geren, L.AC.

• Family Medicine Physician in Mill Valley, CA
• Providers in Mill Valley, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2011; 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.