Healthcare Provider Details

I. General information

NPI: 1356567184
Provider Name (Legal Business Name): KALE CLINTON GENTRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10525 WALMER ST
OVERLAND PARK KS
66212-1886
US

IV. Provider business mailing address

10525 WALMER ST
OVERLAND PARK KS
66212-1886
US

V. Phone/Fax

Practice location:
  • Phone: 913-381-3123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number0412572
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: