| Doctor Name: | MR. GARY JOHN GARDNER |
| NPI Number: | 1003104993 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | N.P. |
| License Number: | 209005922 |
| Business Practice Address: | 4251 Forest Park Ave Saint Louis, MO - 631082810 |
| Business Phone Number: | 6183639545 |
| Business Fax Number: | |
| Mailing Address: | 26 N Pennsylvania Ave, BELLEVILLE |
| State: | IL |
| Postal Code: | 622203952 |
| Phone Number: | 6183639545 |
| Fax Number: | |
| NPI Enumeration Date: | 07/13/2011 |
| NPI Last Update Date: | 08/21/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | 209005922 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |