MEDICARE: ROBERT M GENTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568653285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT M GENTRY

Provider Business Mailing Address
First Line	:	1585 NW WASHINGTON BLVD
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1049
Country	:	US
Telephone Number	:	541-474-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1585 NW WASHINGTON BLVD
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1049
Country	:	US
Telephone Number	:	541-474-5511
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MGR
Name	:	MS. LISA A WILSON
Credential	:
Telephone Number	:	541-474-5511

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	08/13/2007

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