Healthcare Provider Details

I. General information

NPI: 1811067762
Provider Name (Legal Business Name): GARY M GARNER RPH., M.D., FAAHPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GARY GARNER MD

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 500 W SUITE 202
PROVO UT
84604-3305
US

IV. Provider business mailing address

1264 N 1270 E
AMERICAN FORK UT
84003-3520
US

V. Phone/Fax

Practice location:
  • Phone: 801-374-2367
  • Fax:
Mailing address:
  • Phone: 801-592-8536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number150719-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number1507191205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: