Provider Demographics
NPI:1063440766
Name:GARDUNO, TAMARA (MD)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:GARDUNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3649
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-3649
Mailing Address - Country:US
Mailing Address - Phone:509-838-2531
Mailing Address - Fax:
Practice Address - Street 1:3016 E 57TH AVE
Practice Address - Street 2:#24
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-7036
Practice Address - Country:US
Practice Address - Phone:509-838-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8246373Medicaid
WA0242680OtherDEPT OF LABOR AND INDUSTRIES
WA0242682OtherDEPT OF LABOR AND INDUSTRIES
WAG8876574Medicare PIN
WA0242680OtherDEPT OF LABOR AND INDUSTRIES
WAG8876478Medicare PIN
8855981Medicare PIN