Provider Demographics
NPI:1073736567
Name:GENTRY, HAROLD LEFFEL (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:LEFFEL
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 1:609 BEDFORD FOREST CT
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-1006
Mailing Address - Country:US
Mailing Address - Phone:615-758-9859
Mailing Address - Fax:
Practice Address - Street 1:609 BEDFORD FOREST CT
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-1006
Practice Address - Country:US
Practice Address - Phone:615-758-9859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000070232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3150034Medicaid
TN3150036Medicare ID - Type Unspecified