Provider Demographics
NPI:1598013625
Name:GARDNER, ADAM C (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:C
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 N 1100 E
Mailing Address - Street 2:SUITE 203
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2935
Mailing Address - Country:US
Mailing Address - Phone:801-492-2445
Mailing Address - Fax:
Practice Address - Street 1:98 N 1100 E
Practice Address - Street 2:SUITE 203
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2935
Practice Address - Country:US
Practice Address - Phone:801-492-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8403255-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant