Individual
RICKY LANE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
935 N 1000 W, TREMONTON, UT 84337-9356
(435) 207-4800
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9009537-1205
UT
Other
Enumeration date
06/24/2009
Last updated
09/29/2021
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