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General NPI Number Information
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NPI Number | 1124087846
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Entity Type | Individual
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Provider Name | MICHAEL A GENTILE DPM
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 1600 MEDICAL CENTER DR STE G500
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City | HUNTINGTON
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State | WV
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Zip | 25701-3659
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Country | US
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Telephone | 304-691-1262
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Fax |
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Provider Business Mailing Address
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Address Line | 12672 NW BARNES RD STE 100
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City | PORTLAND
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State | OR
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Zip | 97229-6191
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Country | US
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Telephone | 503-336-0169
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | DP00371
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 10473
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License Number State | WV
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