Individual
DR. SCOTT ALLAN GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
175 E ALEX BELL RD, SUITE 212, CENTERVILLE, OH 45459
(509) 254-3121
(937) 999-4174
Mailing address
175 E ALEX BELL RD, SUITE 212, CENTERVILLE, OH 45459
(509) 254-3121
(937) 999-4174
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
35.054539
OH
208600000X
Surgery Physician
M9619
ID
208600000X
Surgery Physician
MD00046059
WA
208600000X
Surgery Physician
MD16480
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012554
—
OR
01
—
0212253
LABOR & INDUSTRY
WA
05
—
1013432
—
WA
01
—
1134119
DMERC
ID
01
—
1568458701
REGENCE BLUESHIELD OF IDAHO
ID
05
—
1568458701
—
ID
01
—
76714
BLUE CROSS
ID
01
—
P00349485
MEDICARE -RR - IDAHO
ID
01
—
P00815199
MEDICARE RR - WA
WA
Enumeration date
09/22/2005
Last updated
09/16/2024
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