Provider Demographics
NPI:1992787006
Name:DAVID GENT & ASSOCIATES PS
Entity type:Organization
Organization Name:DAVID GENT & ASSOCIATES PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:GENT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:360-377-2233
Mailing Address - Street 1:900 SHERIDAN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2701
Mailing Address - Country:US
Mailing Address - Phone:360-377-2233
Mailing Address - Fax:360-377-9131
Practice Address - Street 1:900 SHERIDAN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2701
Practice Address - Country:US
Practice Address - Phone:360-377-2233
Practice Address - Fax:360-377-9131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000724213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1936OtherRR MEDICARE
KI1031OtherREGENCE BLUE SHIELD
162312OtherWA L&I
WA7135809Medicaid
G8854071Medicare PIN
162312OtherWA L&I
WAU89828Medicare UPIN