Individual
DR. MICHAEL BRUCE GENTRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
107 VENTURE CT, GREENWOOD, SC 29649-8558
(864) 538-6565
(864) 538-6566
Mailing address
107 VENTURE CT, GREENWOOD, SC 29649-8558
(864) 538-6565
(864) 538-6566
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
0392
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003926
—
SC
01
—
P00015070
RAILROAD MEDICARE
SC
Enumeration date
05/31/2005
Last updated
03/07/2011
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