Healthcare Provider Details

I. General information

NPI: 1144205329
Provider Name (Legal Business Name): JULIENE CLARE GENTRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULENE CLARE MUELLER MD

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BETHANY HOME RD
PHOENIX AZ
85015-2443
US

IV. Provider business mailing address

9664 E IDAHO AVE
MESA AZ
85209-7061
US

V. Phone/Fax

Practice location:
  • Phone: 602-246-5665
  • Fax: 602-246-5376
Mailing address:
  • Phone: 480-986-0272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA052000
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number36226
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number3203-320
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number329863
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA052000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: