Provider Demographics
NPI:1942329883
Name:GARDNER, JOEL D (DO)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:D
Last Name:GARDNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-3810
Mailing Address - Country:US
Mailing Address - Phone:800-594-6399
Mailing Address - Fax:770-701-6674
Practice Address - Street 1:950 S MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3090
Practice Address - Country:US
Practice Address - Phone:435-734-9471
Practice Address - Fax:770-701-6674
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8821754-1204207L00000X
IDDB1901205207L00000X
IDO0523207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology