MEDICARE: GENTRY C DODD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	0116020159	VA
2	208100000X	Physical Medicine & Rehabilitation Physician	01068858A	IN

General Provider Information

NPI Number	:	1003077272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENTRY C DODD MD

Provider Business Mailing Address
First Line	:	340 W 10TH ST STE 6200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3082
Country	:	US
Telephone Number	:	317-625-6141
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 W 10TH ST STE 6200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3082
Country	:	US
Telephone Number	:	317-625-6141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	07/07/2014

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