Provider Information for 1760828024
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JOEY JAMAR GARDNER Jr.
Sex: Male
NPI: 1760828024
Last Updated: 2023-11-07
Certification Date: 2023-11-07
Certification Date: 2023-11-07
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1760828024 | ||||||||
| Enumeration Date | 2013-05-14 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1090 ARNOLD DR LITTLE ROCK AIR FORCE BASE, AR 72099-4933 United States Phone: 501-987-3080 | Fax: | ||||||||
| Primary Practice Address | 1090 ARNOLD DR LITTLE ROCK AIR FORCE BASE, AR 72099-4933 United States Phone: 501-987-3080 | Fax: | ||||||||
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