Provider Demographics
NPI:1225055783
Name:GARDINER, PETER M (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:GARDINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-9123
Mailing Address - Fax:314-747-9160
Practice Address - Street 1:10 HOSPITAL DR
Practice Address - Street 2:DEPT EMERGENCY MED
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1659
Practice Address - Country:US
Practice Address - Phone:314-362-9123
Practice Address - Fax:314-747-9160
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6D18207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203338520Medicaid
MO203338520Medicaid
MO964805005Medicare PIN
MO203338520Medicaid
F28544Medicare UPIN
IL$$$$$$$$$-1Medicaid
MO011013209Medicare PIN
MO940353210Medicare PIN
MO940353211Medicare PIN
MO940354748Medicare PIN