Provider Demographics
NPI:1285630061
Name:GARDNER, ERIN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:SCOTT
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31236
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-0236
Mailing Address - Country:US
Mailing Address - Phone:314-997-7546
Mailing Address - Fax:314-997-7558
Practice Address - Street 1:3009 N BALLAS RD STE 300A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2354
Practice Address - Country:US
Practice Address - Phone:314-997-7546
Practice Address - Fax:314-997-7558
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-25
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001005039207ND0101X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO070016410OtherRR MEDICARE - STL OFFICE
MO152349OtherBLUE CROSS BLUE SHIELD MO
MO364447622OtherUNITED HEALTHCARE
MO364447622 63703 A001OtherTRICARE
MO36-4447622-71631OtherAETNA
MO364447622OtherCIGNA
MO070016411OtherRR MEDICARE - CAPE OFFICE
MO36-4447622OtherMERCY
MO3644476220001OtherRR MEDICARE
MO36-4447622OtherFIRST HEALTH
MO070016411OtherRR MEDICARE - CAPE OFFICE
MO364447622OtherCIGNA
MO364447622 63703 A001OtherTRICARE