MEDICARE: GARY LEE JENNETT 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	26729	IA

General Provider Information

NPI Number	:	1982693941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY LEE JENNETT M.D.

Provider Business Mailing Address
First Line	:	7003 HIGH POINT LN
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52411-8112
Country	:	US
Telephone Number	:	319-550-2154
Fax Number	:

Provider Business Practice Location Address
First Line	:	7003 HIGH POINT LN
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52411-8112
Country	:	US
Telephone Number	:	319-550-2154
Fax Number	:

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	06/27/2022

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