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Individual

CASEY J GARDNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.C.

Contact information

Practice address
575 RIVERGATE LN UNIT 105, DURANGO, CO 81301-7490
(970) 259-3020
(970) 259-9766
Mailing address
575 RIVERGATE LN UNIT 105, DURANGO, CO 81301-7490
(970) 259-3020
(970) 259-9766

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
10000672A
IN
363AS0400X
Surgical Physician Assistant
Primary
0003579
CO
363AS0400X
Surgical Physician Assistant
10000672A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
151020
MEDICARE PTAN
CO
01
151020TTTT
MEDICARE PTAN NUMBER
IN
05
9000178409
CO
01
P00841261
RAILROAD MEDICARE PTAN NUMBER
IN
Enumeration date
11/07/2005
Last updated
02/19/2024
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