Provider Demographics
NPI:1063721637
Name:GENTRY, GERALDINE
Entity type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:
Last Name:GENTRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 S LOOP W STE 290
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2695
Mailing Address - Country:US
Mailing Address - Phone:713-661-8211
Mailing Address - Fax:713-661-8303
Practice Address - Street 1:2626 S LOOP W STE 290
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2695
Practice Address - Country:US
Practice Address - Phone:713-661-8211
Practice Address - Fax:713-661-8303
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies