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NPI Code Detail

MEDICARE: KENNETH E. GARDNER, M.D., P.A.

MEDICARE: KENNETH E. GARDNER, M.D., P.A.
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
1174400000XSpecialistC-6152AR

General Provider Information

NPI Number : 1952388191
Entity Type Code : Organization
Provider Name (Legal Business Name) : KENNETH E. GARDNER, M.D., P.A.
Provider Business Mailing Address
First Line : 7301 ROGERS AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-4100
Country : US
Telephone Number : 479-314-7545
Fax Number : 479-484-1640
Provider Business Practice Location Address
First Line : 7301 ROGERS AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-4100
Country : US
Telephone Number : 479-314-7545
Fax Number : 479-484-1640
Authorized Official
Title or Position : PRESIDENT
Name : DR. KENNETH E. GARDNER
Credential : M.D.
Telephone Number : 479-314-7545
Provider Enumeration Date : 12/29/2005
Last Update Date : 08/22/2020

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