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General NPI Number Information
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NPI Number | 1285630061
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Entity Type | Individual
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Provider Name | ERIN SCOTT GARDNER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2005
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Last Update Date | 03/04/2022
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Provider Practice Location Address
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Address Line | 3009 N BALLAS RD STE 300A
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2354
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Country | US
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Telephone | 314-997-7546
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Fax | 314-997-7558
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Provider Business Mailing Address
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Address Line | PO BOX 31236
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City | SAINT LOUIS
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State | MO
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Zip | 63131-0236
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Country | US
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Telephone | 314-997-7546
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Fax | 314-997-7558
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 2001005039
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 2001005039
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2001005039
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License Number State | MO
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