Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 005374 | MO |
Y | 213ER0200X | Radiology | 005374 | MO |
NPI | 1942325006 |
---|---|
Provider Name | Dr. Gary Marvin Guebert |
First Address | Maryland Heights, MO 63043-4700 |
Second Address | Maryland Heights, MO 63043-4700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |