Individual
JON B GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
380 CHASE ST, INTERNAL MEDICINE, WALLA WALLA, WA 99362
(509) 525-8110
(509) 522-5743
Mailing address
PO BOX 34439, SEATTLE, WA 98124-1439
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00033931
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447264841
—
WA
Enumeration date
07/28/2006
Last updated
05/20/2021
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