Provider Demographics
NPI:1184644858
Name:GARDNER, RICHARD LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LOUIS
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:P.O. BOX 719
Mailing Address - Street 2:
Mailing Address - City:SOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:93066
Mailing Address - Country:US
Mailing Address - Phone:805-529-1444
Mailing Address - Fax:805-484-8642
Practice Address - Street 1:2240 E GONZALES RD STE 120
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-8212
Practice Address - Country:US
Practice Address - Phone:805-529-1444
Practice Address - Fax:805-484-8642
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56202207Q00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C46674Medicare UPIN
G56202Medicare PIN
CAC46674Medicare UPIN
CAG56202Medicare PIN