Individual
LEE S GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
2725 CHANNING WAY, IDAHO FALLS, ID 83404-7510
(208) 525-8448
(208) 525-8118
Mailing address
2725 CHANNING WAY, IDAHO FALLS, ID 83404-7510
(208) 525-8448
(208) 525-8118
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-359
ID
Other
Enumeration date
11/29/2006
Last updated
12/07/2009
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