Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MN29221 | MN |
NPI | 1003824731 |
---|---|
Provider Name | Dr. Robert N Gardner |
First Address | Paynesville, MN 56362-9470 |
Second Address | Paynesville, MN 56362-1445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 01/12/2009 |