Provider Demographics
NPI:1104008887
Name:GENTRY VU MD INC
Entity Type:Organization
Organization Name:GENTRY VU MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GENTRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-933-0510
Mailing Address - Street 1:534 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6112
Mailing Address - Country:US
Mailing Address - Phone:209-933-0510
Mailing Address - Fax:209-933-0513
Practice Address - Street 1:534 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6112
Practice Address - Country:US
Practice Address - Phone:209-933-0510
Practice Address - Fax:209-933-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90011207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A900110Medicare PIN