Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 1008 | VI |
NPI | 1225035280 |
---|---|
Provider Name | Dr. Walter H Gardiner |
First Address | Christiansted, VI 00821-1728 |
Second Address | Christiansted, VI 00820-4673 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2005 |
Last Update Date | 29/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B03131 | (02) |