Basic Information
Provider Information
NPI: 1982831053
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARD
FirstName: ANDREW
MiddleName: PATRICK
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 982035 NEBRASKA MEDICAL CTR
Address2:  
City: OMAHA
State: NE
PostalCode: 681982035
CountryCode: US
TelephoneNumber: 4025599605
FaxNumber: 4025597779
Practice Location
Address1: 982035 NEBRASKA MEDICAL CTR
Address2:  
City: OMAHA
State: NE
PostalCode: 681982035
CountryCode: US
TelephoneNumber: 4025599605
FaxNumber: 4025597779
Other Information
ProviderEnumerationDate: 06/16/2009
LastUpdateDate: 11/12/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/12/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207T00000X6011NEY Allopathic & Osteopathic PhysiciansNeurological Surgery 

No ID Information.


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