Individual
DR. BRADLEY P GARDNER
Active
Individual
DR. BRADLEY P GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M6282
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010000074
BLUE SHIELD
ID
01
—
000010000077
BLUE SHIELD
ID
01
—
000010000078
BLUE SHIELD
ID
01
—
312742
BLUE CROSS
WY
01
—
5925A
STATE LIC #
WY
01
—
DD552
BLUE CROSS
ID
01
—
DW227
BLUE CROSS
ID
01
—
J4241
BLUE CROSS
ID
01
—
J6428
BLUE CROSS
ID
Enumeration date
11/28/2006
Last updated
07/08/2007
Update your record
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