Provider Demographics
NPI:1689388464
Name:GARDNER, JOSEPH ARCH
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ARCH
Last Name:GARDNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 E STEEP MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5147
Mailing Address - Country:US
Mailing Address - Phone:385-216-9662
Mailing Address - Fax:
Practice Address - Street 1:171 E STEEP MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5147
Practice Address - Country:US
Practice Address - Phone:385-216-9662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other