Provider Demographics
NPI:1316157258
Name:GENTRY, REX NATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:REX
Middle Name:NATHAN
Last Name:GENTRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 LAKE WASHINGTON BLVD S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-4960
Mailing Address - Country:US
Mailing Address - Phone:206-723-1010
Mailing Address - Fax:
Practice Address - Street 1:121 LAKESIDE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-6599
Practice Address - Country:US
Practice Address - Phone:206-324-1200
Practice Address - Fax:206-324-4002
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000164482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB01296Medicare ID - Type Unspecified