Individual
GLENN PIERCE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
20050400008
MO
2086S0129X
Vascular Surgery Physician
Primary
MD 60118824
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001543260
—
PA
01
—
202277
BLUE SHIELD/BLUE CHOICE
MO
05
—
206237307
—
MO
01
—
259599
HEALTHLINK
MO
Enumeration date
04/25/2006
Last updated
03/09/2016
Update your record
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