NPI 1396943825 · live from the CMS NPI Registry
Brian Kowallis Gardner, DPM
Podiatrist, Foot & Ankle Surgery in Roosevelt, UT. National Provider Identifier 1396943825, active.
NPI record
| NPI | 1396943825 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Podiatrist, Foot & Ankle Surgery 213ES0103X |
| Practice location | 210 W 300 N, Roosevelt, UT 84066 |
| Practice phone | 435-722-6163 |
| Enumerated | July 5, 2007 |
| Last updated | May 11, 2017 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Podiatrist, Foot & Ankle Surgery primary | 213ES0103X | 6297901-0501 (UT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.