Provider Demographics
NPI:1376654798
Name:GARDNER, WALTER E (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:E
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 1:8055 O ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2580
Mailing Address - Country:US
Mailing Address - Phone:402-421-0896
Mailing Address - Fax:402-421-0945
Practice Address - Street 1:969 E HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-2547
Practice Address - Country:US
Practice Address - Phone:402-826-3222
Practice Address - Fax:402-826-3228
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1856OtherMIDLANDS CHOICE
NE01-04212OtherUHC
NE06233OtherBCBS
NE278868Medicare PIN
NE01-04212OtherUHC
NE1856OtherMIDLANDS CHOICE
NE06233OtherBCBS