Individual
DR. JONATHAN PAUL GENTILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1234 E DUPONT RD, SUITE 5, FORT WAYNE, IN 46825-1545
(260) 484-7777
Mailing address
1234 E DUPONT RD, SUITE 3, FORT WAYNE, IN 46825-1545
(260) 484-7777
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01018769
IN
207Q00000X
Family Medicine Physician
Primary
01018769
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100049060
—
IN
Enumeration date
02/05/2007
Last updated
02/03/2014
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