Provider Demographics
NPI:1649365917
Name:GARDNER, ROBERT EARL JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EARL
Last Name:GARDNER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1359 N MOUNT AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-1727
Mailing Address - Country:US
Mailing Address - Phone:573-651-3188
Mailing Address - Fax:573-651-3048
Practice Address - Street 1:1359 N MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-1727
Practice Address - Country:US
Practice Address - Phone:573-651-3188
Practice Address - Fax:573-651-3048
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO20050044362084N0600X, 2084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology