Individual
JEREMY G GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1506 S ONEIDA ST, APPLETON, WI 54915-1305
(920) 730-4950
Mailing address
1506 S ONEIDA ST, APPLETON, WI 54915-1305
(920) 730-4950
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
43906
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34344000
—
WI
Enumeration date
09/12/2005
Last updated
07/08/2024
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