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General NPI Number Information
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NPI Number | 1568458701
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Entity Type | Individual
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Provider Name | SCOTT ALLAN GARDNER MD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 175 E ALEX BELL RD SUITE 212
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City | CENTERVILLE
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State | OH
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Zip | 45459
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Country | US
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Telephone | 509-254-3121
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Fax | 937-999-4174
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Provider Business Mailing Address
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Address Line | 175 E ALEX BELL RD SUITE 212
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City | CENTERVILLE
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State | OH
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Zip | 45459
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Country | US
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Telephone | 509-254-3121
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Fax | 937-999-4174
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD16480
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M9619
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD00046059
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35.054539
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License Number State | OH
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