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Individual
DR. WARREN DOUGLAS GENTRY
Active
Individual
DR. WARREN DOUGLAS GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9992
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
# 9992
STATE LICENSE NUMBER
SC
05
—
099921
—
SC
01
—
D907172212
INDIVIDUAL MEDICARE NUMBE
SC
Enumeration date
12/11/2006
Last updated
08/08/2012
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