MEDICARE: DR. MICHAEL BRUCE GENTRY D.O.

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	207V00000X	Obstetrics & Gynecology Physician	0392	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00015070	OTHER	SC	RAILROAD MEDICARE

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	:	1730182064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BRUCE GENTRY D.O.

Provider Business Mailing Address
First Line	:	107 VENTURE CT
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29649-8558
Country	:	US
Telephone Number	:	864-538-6565
Fax Number	:	864-538-6566

Provider Business Practice Location Address
First Line	:	107 VENTURE CT
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29649-8558
Country	:	US
Telephone Number	:	864-538-6565
Fax Number	:	864-538-6566

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	03/07/2011

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