MEDICARE: DR. GARY CARL GARD PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	181	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	103230	OTHER	NE	MANAGED HEALTH NETWORK
3	048369	OTHER	NE	VALUEOPTIONS
4	08430	OTHER	NE	BLUE CROSS / BLUE SHIELD
5	4786	OTHER	NE	MIDLANDS CHOICE

General Provider Information

NPI Number	:	1588673701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY CARL GARD PH.D

Provider Business Mailing Address
First Line	:	10040 REGENCY CIR
Second Line	:	SUITE 250
City	:	OMAHA
State	:	NE
Zip	:	68114-3723
Country	:	US
Telephone Number	:	402-393-5432
Fax Number	:	402-393-0220

Provider Business Practice Location Address
First Line	:	10040 REGENCY CIR
Second Line	:	SUITE 250
City	:	OMAHA
State	:	NE
Zip	:	68114-3723
Country	:	US
Telephone Number	:	402-393-5432
Fax Number	:	402-393-0220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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