Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 2009015805 | MO |
N | 207R00000X | Internist | 39589 | CO |
N | 111NI0900X | Internist | 39589 | CO |
NPI | 1083668172 |
---|---|
Provider Name | Dr. Terry G Gardner |
First Address | Chesterfield, MO 63017-1823 |
Second Address | Chesterfield, MO 63017-1823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 23/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A10548 | (02) | CO |