Individual
DR. GEORGE GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5409 N KNOXVILLE AVE, PEORIA, IL 61615
(309) 682-7750
(309) 682-7786
Mailing address
PO BOX 3853, PEORIA, IL 61612-3853
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036-080941
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007222342
BLUE CROSS BLUE SHIELD
IL
05
—
036080941-1
—
IL
01
—
054573
HEALTH ALLIANCE
IL
01
—
1005156
ACR
IL
01
—
211015
HEALTHLINK
IL
01
—
300027879
RAILROAD MEDICARE
IL
01
—
370947902
TRICARE CHAMPUS
IL
01
—
IL0100
JOHN DEERE
IL
Enumeration date
01/04/2006
Last updated
07/02/2024
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