Provider Demographics
NPI:1477862969
Name:GARDNER, LARS BENJAMIN (DO)
Entity Type:Individual
Prefix:DR
First Name:LARS
Middle Name:BENJAMIN
Last Name:GARDNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5838 SIX FORKS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3885
Mailing Address - Country:US
Mailing Address - Phone:919-785-3400
Mailing Address - Fax:
Practice Address - Street 1:5838 SIX FORKS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3885
Practice Address - Country:US
Practice Address - Phone:919-785-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125056507207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery