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NPI Code Detail

MEDICARE: DAVID A GARDNER DO

MEDICARE: DAVID A GARDNER DO
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
1207P00000XEmergency Medicine PhysicianO-1935ID
2207Q00000XFamily Medicine PhysicianO-1935ID
3207Q00000XFamily Medicine PhysicianE-19096AR

General Provider Information

NPI Number : 1841937778
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID A GARDNER DO
Provider Business Mailing Address
First Line : PO BOX 776084
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6084
Country : US
Telephone Number : 479-637-4135
Fax Number : 479-637-3523
Provider Business Practice Location Address
First Line : 1341 W 6TH ST
Second Line :
City : WALDRON
State : AR
Zip : 72958-7642
Country : US
Telephone Number : 479-637-4135
Fax Number : 479-637-3523
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2022
Last Update Date : 03/18/2026

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Directions to “ DAVID A GARDNER DO” Practice Location

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