Provider Demographics
NPI:1235690462
Name:GARDNER, LEX JORDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LEX
Middle Name:JORDAN
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 1:1700 NICHOLASVILLE RD STE 701
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1467
Mailing Address - Country:US
Mailing Address - Phone:859-278-0396
Mailing Address - Fax:859-277-5414
Practice Address - Street 1:1700 NICHOLASVILLE RD STE 701
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1467
Practice Address - Country:US
Practice Address - Phone:859-278-0396
Practice Address - Fax:859-277-5414
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT217832207V00000X
390200000X
KY58288207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program