NPI 1063589612

Lee S Gardner, PAC

Practitioner Medical Physician Assistant Idaho Falls, ID

Practice location

Address: 2725 Channing Way, Idaho Falls, ID 83404-7510
Phone: (208) 525-8448
Fax: (208) 525-8118

Registered specialties

Medical Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AM0700X Licence PA-359 (ID)

Other Physician Assistant providers in Idaho →

Registry record

NPI: 1063589612
Entity type: Individual
Sex (as registered): Male
NPI issued: 29 Nov 2006
Record last updated: 7 Dec 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.