Individual
JEFF GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
398 S 75 W, FARMINGTON, UT 84025-2307
(801) 721-1614
Mailing address
398 S 75 W, FARMINGTON, UT 84025-2307
(801) 721-1614
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
12611471-004-STC
UT
Other
Enumeration date
03/13/2013
Last updated
03/13/2013
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