Individual
DR. WARREN DOUGLAS GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
522 COLLEGE AVE, SUITE 1, CLEMSON, SC 29631-1443
(864) 654-7841
(864) 654-7641
Mailing address
522 COLLEGE AVE, SUITE 1, CLEMSON, SC 29631-1443
(864) 654-7841
(864) 654-7641
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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