Doctor Name: | DR. JOEL D. GARDNER |
NPI Number: | 1942329883 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | 5101016971 |
Business Practice Address: | 777 Hospital Way Pocatello, ID - 832012753 |
Business Phone Number: | 2082392500 |
Business Fax Number: | |
Mailing Address: | 777 Hospital Way, Portneuf Medical Center POCATELLO |
State: | ID |
Postal Code: | 83201 |
Phone Number: | 2082392222 |
Fax Number: | |
NPI Enumeration Date: | 03/29/2007 |
NPI Last Update Date: | 11/11/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 5101016971 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |