Individual
ALLEN RICHARD GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3120 CLEARWATER DR, PRESCOTT, AZ 86305-7131
(928) 771-3704
(928) 771-0434
Mailing address
PO BOX 10880, PRESCOTT, AZ 86304-0880
(928) 759-5987
(928) 458-2039
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
31108
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
785701
—
AZ
Enumeration date
07/10/2006
Last updated
09/16/2015
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