Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 01025354A | IN |
NPI | 1215948427 |
---|---|
Provider Name | Dr. William Lee Gentry |
First Address | Indianapolis, IN 46280-2301 |
Second Address | Indianapolis, IN 46280-2301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000084731 | ANTHEM (01) | IN |
100326540C | (05) | IN |
B00108 | (02) | IN |