MEDICARE: JAMES D GENTRY MD

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	207Q00000X	Family Medicine Physician	BP10041305	TX
2	207Q00000X	Family Medicine Physician	23268	MS

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	:	1568756252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES D GENTRY MD

Provider Business Mailing Address
First Line	:	PO BOX 470
Second Line	:
City	:	LOUISVILLE
State	:	MS
Zip	:	39339-0470
Country	:	US
Telephone Number	:	662-773-3503
Fax Number	:	662-773-6457

Provider Business Practice Location Address
First Line	:	17540 E MAIN ST
Second Line	:
City	:	LOUISVILLE
State	:	MS
Zip	:	39339-2772
Country	:	US
Telephone Number	:	662-773-3503
Fax Number	:	662-773-6457

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2011
Last Update Date	:	04/25/2024

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