Provider Demographics
NPI:1962498113
Name:GARNEAU, ROBERT A (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:GARNEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2421 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7115
Mailing Address - Country:US
Mailing Address - Phone:270-442-8272
Mailing Address - Fax:270-444-0539
Practice Address - Street 1:2725 JAMES SANDERS BLVD STE A
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-8405
Practice Address - Country:US
Practice Address - Phone:270-554-5114
Practice Address - Fax:270-215-4834
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY277942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64277940Medicaid
KY64377940Medicaid
KY0502504Medicare ID - Type Unspecified
KY0502604Medicare ID - Type Unspecified
KY0502404Medicare ID - Type Unspecified
KY64377940Medicaid