Provider Demographics
NPI:1295841435
Name:GENTRY, JONATHON B (MD)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:B
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 1:705 QUAIL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124
Mailing Address - Country:US
Mailing Address - Phone:806-353-6400
Mailing Address - Fax:
Practice Address - Street 1:705 QUAIL CREEK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124
Practice Address - Country:US
Practice Address - Phone:806-353-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3653207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128496101OtherSOUTHWEST LIFE & HEALTH
TXP00045563OtherMEDICARE RAILROAD
NM22454772Medicaid
TX151644501Medicaid
OK200004050AMedicaid
TX88392SOtherBCBS
TX128496101OtherFIRST CARE
TX151644501Medicaid
TX128496101OtherSOUTHWEST LIFE & HEALTH