Provider Demographics
NPI:1205818069
Name:GENT, DAVID MONROE (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MONROE
Last Name:GENT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000724213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA162311OtherWA L&I
WA9055526OtherMEDICAID DME
WA8321366Medicaid
P00026782OtherRR MCR
WA4205GEOtherBC/BS PROVIDER #
WA162311OtherWA L&I
WA8321366Medicaid
WAU89828Medicare UPIN
G008854072Medicare PIN