Provider Demographics
NPI:1487640926
Name:GARDNER, CAMERON (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:
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:PO BOX 1459
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-1459
Mailing Address - Country:US
Mailing Address - Phone:406-892-3208
Mailing Address - Fax:406-892-4535
Practice Address - Street 1:2165 9TH STREET W
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-2165
Practice Address - Country:US
Practice Address - Phone:406-892-3208
Practice Address - Fax:406-892-4535
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0091868Medicaid
MT0091868Medicaid
MTI24129Medicare UPIN