Individual
JONATHON B GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
L3653
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128496101
SOUTHWEST LIFE & HEALTH
TX
05
—
151644501
—
TX
05
—
200004050A
—
OK
05
—
22454772
—
NM
01
—
88392S
BCBS
TX
01
—
P00045563
MEDICARE RAILROAD
TX
Enumeration date
08/21/2006
Last updated
11/07/2024
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