| Doctor Name: | ROBERT WILLIAM GARDNER |
| NPI Number: | 1023183829 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | G30366 |
| Business Practice Address: | 6300 E. Hwy 20 Lucerne, CA - 95458 |
| Business Phone Number: | 7072749299 |
| Business Fax Number: | 7072749297 |
| Mailing Address: | 10458 Chatten Court, CLEARLAKE OAKS |
| State: | CA |
| Postal Code: | 954237050 |
| Phone Number: | 7072749299 |
| Fax Number: | 7072749297 |
| NPI Enumeration Date: | 11/21/2006 |
| NPI Last Update Date: | 11/01/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0401X |
| License Number: | G30366 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A family medicine physician who specializes in the diagnosis and treatment of addictions. |