Provider Demographics
NPI:1881639060
Name:GARDNER, ERIC J (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:GARDNER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2 W 42ND ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-0617
Mailing Address - Country:US
Mailing Address - Phone:308-635-1414
Mailing Address - Fax:308-635-1913
Practice Address - Street 1:2 W 42ND ST
Practice Address - Street 2:SUITE 120
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-0617
Practice Address - Country:US
Practice Address - Phone:308-635-1414
Practice Address - Fax:308-635-1913
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2012-08-13
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Provider Licenses
StateLicense IDTaxonomies
NE26457207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery