Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 2001005039 | MO |
N | 207ND0101X | MOHS-Micrographic Surgeon | 2001005039 | MO |
N | 207NS0135X | Procedural Dermatology | 2001005039 | MO |
NPI | 1285630061 |
---|---|
Provider Name | Dr. Erin Scott Gardner |
First Address | Saint Louis, MO 63127-0686 |
Second Address | Saint Louis, MO 63127-1628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2005 |
Last Update Date | 18/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070016410 | RR MEDICARE - STL OFFICE (01) | MO |
070016411 | RR MEDICARE - CAPE OFFICE (01) | MO |
152349 | BLUE CROSS BLUE SHIELD MO (01) | MO |
364447622 | CIGNA (01) | MO |
364447622 | UNITED HEALTHCARE (01) | MO |
36-4447622 | FIRST HEALTH (01) | MO |
36-4447622 | MERCY (01) | MO |
364447622 63703 A001 | TRICARE (01) | MO |
3644476220001 | RR MEDICARE (01) | MO |
36-4447622-71631 | AETNA (01) | MO |
H23275 | (02) | MO |