Provider Demographics
NPI:1548471832
Name:GARDNER, MEGAN E (MD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:E
Last Name:GARDNER
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 1:2400 HOSPITAL DR.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2386
Mailing Address - Country:US
Mailing Address - Phone:318-742-6710
Mailing Address - Fax:318-747-5393
Practice Address - Street 1:2400 HOSPITAL DR.
Practice Address - Street 2:SUITE 120
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2386
Practice Address - Country:US
Practice Address - Phone:318-742-6710
Practice Address - Fax:318-747-5393
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202868208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1000019Medicaid
LA00001Medicaid