Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 166163 | NC |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | DR.0058077 | CO |
NPI | 1083927131 |
---|---|
Provider Name | Dr. Bennett R Gardner |
First Address | Denver, CO 80247-1314 |
Second Address | Lone Tree, CO 80124-5425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2010 |
Last Update Date | 09/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
027450 | KAISER COMMERCIAL NUMBER (01) | CO |