Organization
GARDNER & GARDNER, PA
Active
Other names
Cama Prairie Family Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIM GARDNER MO (PRESIDENT)
(208) 983-3000
Entity
Organization
Contact information
Practice address
203 N A ST, GRANGEVILLE, ID 83530-1201
(208) 983-3000
(208) 983-9276
Mailing address
203 N A ST, GRANGEVILLE, ID 83530-1201
(208) 983-3000
(208) 983-9276
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M6670
ID
207Q00000X
Family Medicine Physician
M6671
ID
207Q00000X
Family Medicine Physician
NP416A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G02767400
—
ID
Enumeration date
07/11/2005
Last updated
08/22/2020
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