MEDICARE: DR. KIM R 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	207RG0100X	Gastroenterology Physician	H7303	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00N91F	OTHER	TX	BCBS GRP
4	8F7163	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1396736187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIM R GENTRY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 35629
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-0629
Country	:	US
Telephone Number	:	214-424-2213
Fax Number	:	214-231-2159

Provider Business Practice Location Address
First Line	:	1001 N WALDROP DR
Second Line	:	STE. 509
City	:	ARLINGTON
State	:	TX
Zip	:	76012-4705
Country	:	US
Telephone Number	:	817-394-4300
Fax Number	:	817-394-0200

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	05/23/2013

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Directions to “ DR. KIM R GENTRY M.D.” Practice Location

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