Individual
JOHN RUSSELL GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
601 N 30TH ST, OMAHA, NE 68131-2137
(402) 449-4590
Mailing address
PO BOX 3366-0210, OMAHA, NE 68176-0210
(866) 321-8433
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
23872
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025121700
—
NE
01
—
252841
MIDLANDS CHOICE
NE
01
—
34348
BCBSNE
NE
Enumeration date
10/11/2006
Last updated
10/20/2008
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