MEDICARE: DEL R GARDNER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DO1834	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000079452	OTHER	IN	ANTHEM, BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336157585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEL R GARDNER DO

Provider Business Mailing Address
First Line	:	9010 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8932
Country	:	US
Telephone Number	:	702-240-8646
Fax Number	:	702-240-0206

Provider Business Practice Location Address
First Line	:	4845 S RAINBOW BLVD STE 402
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4750
Country	:	US
Telephone Number	:	702-362-9800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/14/2025

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Directions to “ DEL R GARDNER DO” Practice Location

Language	Start Address	Practice Location

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