Provider Demographics
NPI:1073664041
Name:DANNIE J GENTRY MD PC
Entity Type:Organization
Organization Name:DANNIE J GENTRY MD PC
Other - Org Name:LUDINGTON OB GYN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNIE
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:231-843-6767
Mailing Address - Street 1:250 N NELSON RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1942
Mailing Address - Country:US
Mailing Address - Phone:231-843-6767
Mailing Address - Fax:231-843-6522
Practice Address - Street 1:250 N NELSON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1942
Practice Address - Country:US
Practice Address - Phone:231-843-6767
Practice Address - Fax:231-843-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073931207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG94118Medicare UPIN
MNP39940001Medicare PIN