Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 0412572 | KS |
NPI | 1356567184 |
---|---|
Provider Name | Kale Clinton Gentry |
First Address | Overland Park, KS 66212-1886 |
Second Address | Overland Park, KS 66212-1886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2007 |