Provider Demographics
NPI:1881610863
Name:GARDNER, RONALD SHEARER (MD)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:SHEARER
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-1010
Mailing Address - Country:US
Mailing Address - Phone:406-883-5680
Mailing Address - Fax:406-883-8910
Practice Address - Street 1:6 13TH AVE E
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-5315
Practice Address - Country:US
Practice Address - Phone:406-883-5680
Practice Address - Fax:406-883-8910
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5117A208600000X
MT12233208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY5117AOtherPHYSICIAN LICENSE
WY107193900Medicaid
WY107193900Medicaid
WY5117AOtherPHYSICIAN LICENSE
MTM011001232Medicare UPIN