Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2005004436 | MO |
Y | 2084N0400X | Neurologist | 2005004436 | MO |
N | 2084N0600X | Clinical Neurophysiologist | 2005004436 | MO |
NPI | 1649365917 |
---|---|
Provider Name | Dr. Robert Earl Gardner Jr |
First Address | Cape Girardeau, MO 63703-5031 |
Second Address | Cape Girardeau, MO 63703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 27/02/2020 |