=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992787006
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID GENT & ASSOCIATES PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2005
-----------------------------------------------------
Last Update Date | 12/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 SHERIDAN RD SUITE 101
-----------------------------------------------------
City | BREMERTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98310-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-377-2233
-----------------------------------------------------
Fax | 360-377-9131
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 SHERIDAN RD SUITE 101
-----------------------------------------------------
City | BREMERTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98310-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-377-2233
-----------------------------------------------------
Fax | 360-377-9131
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/DOCTOR
-----------------------------------------------------
Name | DAVID MONROE GENT
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 360-377-2233
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | PO00000724
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------