Healthcare Provider Details

I. General information

NPI: 1043329899
Provider Name (Legal Business Name): PETER CHARLES GENTRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 INDUSTRIAL BLVD
HARVEY LA
70058-2314
US

IV. Provider business mailing address

2208 MANHATTAN AVE
MANHATTAN BEACH CA
90266-4425
US

V. Phone/Fax

Practice location:
  • Phone: 504-366-7638
  • Fax:
Mailing address:
  • Phone: 310-802-9181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number024771
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA90911
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number024771
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberA90911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: