Provider Demographics
NPI:1316930019
Name:GARD, DAVID HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HENRY
Last Name:GARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:HENRY
Other - Last Name:GARD BORONDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX LBJ GENERAL DELIVERY
Mailing Address - Street 2:LBJ TROPICAL MEDICAL CENTER
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799
Mailing Address - Country:US
Mailing Address - Phone:684-633-1683
Mailing Address - Fax:684-633-1976
Practice Address - Street 1:123 TURNER LANE
Practice Address - Street 2:LBJ TROPICAL MEDICAL CENTER
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799
Practice Address - Country:US
Practice Address - Phone:684-633-1683
Practice Address - Fax:684-633-1976
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37957208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery