Provider Demographics
NPI:1215948427
Name:GENTRY, WILLIAM LEE (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEE
Last Name:GENTRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:201 PENNSYLVANIA PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-2301
Mailing Address - Country:US
Mailing Address - Phone:317-817-1300
Mailing Address - Fax:317-817-1306
Practice Address - Street 1:201 PENNSYLVANIA PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-2301
Practice Address - Country:US
Practice Address - Phone:317-817-1300
Practice Address - Fax:317-817-1306
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025354A207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000084731OtherANTHEM
IN100326540CMedicaid
INB00108Medicare UPIN
IN660530Medicare ID - Type Unspecified