Individual
SAMUEL D GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
805 MAIN ST, SALMON, ID 83467-0000
(208) 756-6212
(208) 756-6336
Mailing address
203 S DAISY ST, SALMON, ID 83467-0000
(208) 756-5600
(208) 756-4169
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-174
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
804213400
—
ID
Enumeration date
10/31/2006
Last updated
09/26/2011
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