Provider Demographics
NPI:1144205329
Name:GENTRY, JULIENE CLARE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIENE
Middle Name:CLARE
Last Name:GENTRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULENE
Other - Middle Name:CLARE
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9664 E IDAHO AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-7061
Mailing Address - Country:US
Mailing Address - Phone:480-986-0272
Mailing Address - Fax:
Practice Address - Street 1:2000 W BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2443
Practice Address - Country:US
Practice Address - Phone:602-246-5665
Practice Address - Fax:602-246-5376
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA052000207R00000X, 208000000X
AZ36226208M00000X
WI3203-320208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ164441Medicaid
AZ1144205329OtherBCBS OF ARIZONA
F65012Medicare UPIN
AZ164441Medicaid