Individual
MICHAEL J GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 HOSPITAL DR, COLUMBIA, MO 65212-0001
(573) 882-2273
(573) 884-4609
Mailing address
PO BOX 7687, COLUMBIA, MO 65205-7687
(573) 882-2259
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2006023034
MO
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
2006023034
MO
208000000X
Pediatrics Physician
20060213034
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111238
BLUE SHIELD
MO
05
—
205460702
—
MO
01
—
772006
HEALTHLINK
MO
Enumeration date
09/20/2006
Last updated
09/14/2022
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