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NPI Code Detail

MEDICARE: DR. DOUGLAS JAMES GENTRY MD

MEDICARE: DR. DOUGLAS JAMES GENTRY 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
1207Q00000XFamily Medicine Physician4301076105MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20531024OTHERMIBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1245224435
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOUGLAS JAMES GENTRY MD
Provider Business Mailing Address
First Line : PO BOX 27127
Second Line :
City : LANSING
State : MI
Zip : 48909-7127
Country : US
Telephone Number : 231-346-6800
Fax Number : 231-346-6017
Provider Business Practice Location Address
First Line : 1105 SIXTH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-2345
Country : US
Telephone Number : 231-935-5000
Fax Number : 231-346-6017
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2005
Last Update Date : 11/25/2022

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