Provider Demographics
NPI:1285612242
Name:GARNER, ROBERT W (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:GARNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 CROSS ST STE 230
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2988
Mailing Address - Country:US
Mailing Address - Phone:618-607-1260
Mailing Address - Fax:
Practice Address - Street 1:1414 CROSS ST STE 230
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-2988
Practice Address - Country:US
Practice Address - Phone:618-607-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-113196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
678480001OtherDMERC
MO155842OtherBLUE CROSS BLUE SHIELD
2534093OtherUHC/COMMERCIAL
7887689OtherAETNA
IL938615897OtherBLUE CROSS BLUE SHIELD
P00249546OtherRAILROAD MEDICARE
265633OtherGROUP HEALTH PLAN
724150OtherHEALTHLINK
109054OtherHEALTH ALLIANCE
K20882Medicare PIN
I41383Medicare UPIN