Provider Demographics
NPI:1013344365
Name:GARD, STEVEN V (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:V
Last Name:GARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WEST MAIN, BOX Q
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59645
Mailing Address - Country:US
Mailing Address - Phone:406-547-3321
Mailing Address - Fax:406-547-3298
Practice Address - Street 1:16 WEST MAIN, BOX Q
Practice Address - Street 2:
Practice Address - City:WHITE SULPHUR SPINGS
Practice Address - State:MT
Practice Address - Zip Code:59645
Practice Address - Country:US
Practice Address - Phone:406-547-3321
Practice Address - Fax:406-547-3298
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PAC-LIC-27440363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMED-PAC-LIC-27440OtherNEW GRAD