Gardner, Larry Wayne

Gardner, Larry Wayne is an individual health care provider with primary practice located at 143 Garden Homes Dr , Colville WA 99114-9229. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Dermatopathology. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. Gardner, Larry Wayne can be contacted via phone (509) 684-3701.

Contact Information

Primary practice address
143 Garden Homes Dr Colville WA 99114-9229
Phone: (509) 684-3701
Fax: (509) 684-5817
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 3301 Nevada
Allopathic & Osteopathic Physicians / Dermatopathology 207ND0900X 3301 Nevada

Profile Details

NPI number 1114095437
LBN Legal business name Gardner, Larry Wayne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 4th, 2006
Last updated Apr 23rd, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114095437 NPPES
Nevada MEDICAID 002016241

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