Individual
JONATHAN M GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
935 N 1000 W, TREMONTON, UT 84337-9356
(435) 207-4800
(435) 207-4808
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(435) 207-4800
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8390890-1205
UT
207Q00000X
Family Medicine Physician
M12339
ID
207Y00000X
Otolaryngology Physician
M12339
ID
Other
Enumeration date
08/11/2011
Last updated
08/10/2021
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