Provider Demographics
NPI:1154598746
Name:GENTRY, BELLA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:BELLA
Middle Name:MARIE
Last Name:GENTRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BELLA
Other - Middle Name:MARIE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 861
Mailing Address - Street 2:
Mailing Address - City:CROW AGENCY
Mailing Address - State:MT
Mailing Address - Zip Code:59022-0861
Mailing Address - Country:US
Mailing Address - Phone:406-638-2959
Mailing Address - Fax:
Practice Address - Street 1:13 E MAKPAS AVE
Practice Address - Street 2:
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022
Practice Address - Country:US
Practice Address - Phone:406-638-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA25561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E24314Medicare UPIN