Provider Demographics
NPI:1285655746
Name:GARDNER, NOEL C (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:C
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 1:515 E 4500 S STE G220
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5702
Mailing Address - Country:US
Mailing Address - Phone:801-590-9557
Mailing Address - Fax:801-590-9957
Practice Address - Street 1:515 E 4500 S STE G220
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-590-9557
Practice Address - Fax:801-590-9957
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT17885212052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry