Individual
KEVIN HALL GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1055 N 500 W, STE 111, PROVO, UT 84604-3305
(801) 374-8999
(801) 429-8063
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 374-8999
(801) 429-8063
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
54109
MN
207N00000X
Dermatology Physician
Primary
9332631-1204
UT
207ND0101X
MOHS-Micrographic Surgery Physician
9332631-1204
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/17/2010
Last updated
09/08/2021
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