Provider Demographics
NPI:1811067762
Name:GARNER, GARY M (RPH, MD, FAAHPM)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:GARNER
Suffix:
Gender:M
Credentials:RPH, MD, FAAHPM
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:GARNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1264 N 1270 E
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3520
Mailing Address - Country:US
Mailing Address - Phone:801-592-8536
Mailing Address - Fax:
Practice Address - Street 1:1055 N 500 W
Practice Address - Street 2:SUITE 202
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3305
Practice Address - Country:US
Practice Address - Phone:801-374-2367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT150719-1205207Q00000X
UT1507191205207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine