MEDICARE: JAMES WILLIAM GARDNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD216301	OR
2	207Q00000X	Family Medicine Physician	M6671	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730275876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES WILLIAM GARDNER MD

Provider Business Mailing Address
First Line	:	PO BOX 190930
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83719-0930
Country	:	US
Telephone Number	:	208-302-7100
Fax Number	:	208-302-7155

Provider Business Practice Location Address
First Line	:	3025 W CHERRY LN STE A
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-8531
Country	:	US
Telephone Number	:	208-302-7100
Fax Number	:	208-302-7155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	01/05/2026

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Directions to “ JAMES WILLIAM GARDNER MD” Practice Location

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