MEDICARE: DR. ROBERT MARK GENTRY M.D.

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	207Q00000X	Family Medicine Physician	MD11487	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080085678	OTHER	OR	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255338471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT MARK GENTRY M.D.

Provider Business Mailing Address
First Line	:	1585 NW WASHINGTON BLVD
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1049
Country	:	US
Telephone Number	:	541-474-5511
Fax Number	:	541-474-1662

Provider Business Practice Location Address
First Line	:	1585 NW WASHINGTON BLVD
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1049
Country	:	US
Telephone Number	:	541-474-5511
Fax Number	:	541-474-1662

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	07/01/2010

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