Provider Demographics
NPI:1003924879
Name:GARDNER, RICHARD DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DENNIS
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SHELTER COVE LN
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-3575
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9 SHELTER COVE LN
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-3575
Practice Address - Country:US
Practice Address - Phone:843-422-5320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26366207X00000X
TNMD009475207X00000X
SC16044207X00000X
NC35902207X00000X
MT10814207X00000X
NMMD2005-0607207X00000X
OK24746207X00000X
LAMD05635R207X00000X
CA52397207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery