Healthcare Provider Details

I. General information

NPI: 1023325875
Provider Name (Legal Business Name): ROBERT BALL GARDNER AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MADISON ST STE 201
DENVER CO
80206-5411
US

IV. Provider business mailing address

90 MADISON ST STE 201
DENVER CO
80206-5411
US

V. Phone/Fax

Practice location:
  • Phone: 303-322-0054
  • Fax: 303-355-5879
Mailing address:
  • Phone: 303-322-0054
  • Fax: 303-355-5879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD-590
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: