Provider Demographics
NPI:1699702472
Name:GARDINER, GENA MATHEWS (MD)
Entity type:Individual
Prefix:DR
First Name:GENA
Middle Name:MATHEWS
Last Name:GARDINER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:17701 EDISON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1266
Mailing Address - Country:US
Mailing Address - Phone:636-735-4122
Mailing Address - Fax:636-735-4123
Practice Address - Street 1:17701 EDISON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1266
Practice Address - Country:US
Practice Address - Phone:636-735-4122
Practice Address - Fax:636-735-4123
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK16872207Q00000X
MOR8G73207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine