Provider Demographics
NPI:1063515955
Name:DAN GARDNER INC
Entity type:Organization
Organization Name:DAN GARDNER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:352-795-5377
Mailing Address - Street 1:700 SE 5TH TERR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4877
Mailing Address - Country:US
Mailing Address - Phone:352-795-5377
Mailing Address - Fax:352-795-8663
Practice Address - Street 1:700 SE 5TH TERR
Practice Address - Street 2:SUITE 12
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4877
Practice Address - Country:US
Practice Address - Phone:352-795-5377
Practice Address - Fax:352-795-8663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ0279OtherBLUE CROSS & BLUE SHIELD
FLS0820Medicare ID - Type Unspecified