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General NPI Number Information
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NPI Number | 1841937778
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Entity Type | Individual
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Provider Name | DAVID A GARDNER DO
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Gender | Male
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Dates
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Enumeration Date | 05/12/2022
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 1341 W 6TH ST
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City | WALDRON
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State | AR
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Zip | 72958-7642
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Country | US
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Telephone | 479-637-4135
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Fax | 479-637-3523
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Provider Business Mailing Address
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Address Line | PO BOX 776084
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City | CHICAGO
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State | IL
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Zip | 60677-6084
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Country | US
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Telephone | 479-637-4135
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Fax | 479-637-3523
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-19096
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MRO-2162
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License Number State | ID
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