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NPI Code Detail

MEDICARE: HEATHER L GARDNER MD

MEDICARE: HEATHER L GARDNER MD
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
1208000000XPediatrics PhysicianDR.0053785CO

General Provider Information

NPI Number : 1700173242
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER L GARDNER MD
Provider Business Mailing Address
First Line : 1905 BLAKE AVE STE 201
Second Line :
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-4286
Country : US
Telephone Number : 970-947-9999
Fax Number : 970-947-9226
Provider Business Practice Location Address
First Line : 1905 BLAKE AVE STE 201
Second Line :
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-4286
Country : US
Telephone Number : 970-947-9999
Fax Number : 970-947-9226
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2011
Last Update Date : 06/24/2014

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Directions to “ HEATHER L GARDNER MD” Practice Location

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