Healthcare Provider Details

I. General information

NPI: 1841937778
Provider Name (Legal Business Name): DAVID A GARDNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 W 6TH ST
WALDRON AR
72958-7642
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 479-637-4135
  • Fax: 479-637-3523
Mailing address:
  • Phone: 479-637-4135
  • Fax: 479-637-3523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberO-1935
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO-1935
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-19096
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: