MEDICARE: CHET M 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
1	207Q00000X	Family Medicine Physician	23607	TN
2	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	23607	TN

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	:	1851380406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHET M GENTRY MD

Provider Business Mailing Address
First Line	:	3300 WILLIAMS ENTERPRISE DR
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-4280
Country	:	US
Telephone Number	:	931-528-9222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 WILLIAMS ENTERPRISE DR
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-4280
Country	:	US
Telephone Number	:	931-528-9222
Fax Number	:

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	06/02/2014

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Directions to “ CHET M GENTRY MD” Practice Location

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