Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 01068858A | IN |
NPI | 1003077272 |
---|---|
Provider Name | Gentry C Dodd |
First Address | Indianapolis, IN 46202-3082 |
Second Address | Indianapolis, IN 46202-3082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2008 |
Last Update Date | 07/07/2014 |