Individual
DAVID GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4715 VIEWRIDGE AVE STE 230, SAN DIEGO, CA 92123-1680
(800) 257-8715
(800) 819-1655
Mailing address
3429 WHARTON DR, FORT WORTH, TX 76133-2231
(817) 346-7378
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2-4381
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113238302
—
TX
01
—
86068A
BCBS
TX
Enumeration date
09/01/2006
Last updated
07/08/2007
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