Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 2016016730 | MO |
NPI | 1093861601 |
---|---|
Provider Name | John Brian Garner |
First Address | Springfield, MO 65808-9007 |
Second Address | Springfield, MO 65807-5209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 18/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093861601 | (05) | MO |
200033543 | (05) | MO |