Provider Demographics
NPI:1538298617
Name:KENT E GARDNER, M.D., P.C.
Entity Type:Organization
Organization Name:KENT E GARDNER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-628-3334
Mailing Address - Street 1:1490 E FOREMASTER DR STE 350
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4507
Mailing Address - Country:US
Mailing Address - Phone:435-628-3334
Mailing Address - Fax:435-628-3375
Practice Address - Street 1:1490 E FOREMASTER DR STE 350
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4507
Practice Address - Country:US
Practice Address - Phone:435-628-3334
Practice Address - Fax:435-628-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT371391-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty