MEDICARE: ROBERT A.M. GARDERE M.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	208200000X	Plastic Surgery Physician	E7938	TX

General Provider Information

NPI Number	:	1811001951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT A.M. GARDERE M.D.

Provider Business Mailing Address
First Line	:	3115 PINE AVE
Second Line	:	STE#908
City	:	WACO
State	:	TX
Zip	:	76708-3247
Country	:	US
Telephone Number	:	254-752-2575
Fax Number	:	254-752-0188

Provider Business Practice Location Address
First Line	:	3115 PINE AVE
Second Line	:	STE#908
City	:	WACO
State	:	TX
Zip	:	76708-3247
Country	:	US
Telephone Number	:	254-752-2575
Fax Number	:	254-752-0188

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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