Individual
NEVEN JOHN GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
166 PASADENA DR, SUITE 150, LEXINGTON, KY 40503-2973
(859) 276-1452
(859) 277-1237
Mailing address
PO BOX 2209, SKYLAND, NC 28776-2209
(800) 341-8067
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
19637
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275307
MEDICARE INDIVIDUAL #
—
05
—
64196371
—
KY
01
—
710017290
MEDICAID GROUP #
KY
Enumeration date
08/10/2005
Last updated
10/25/2013
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