Provider Demographics
NPI:1437842358
Name:GENTRY, MIKEL CLIFFORD (MD)
Entity Type:Individual
Prefix:
First Name:MIKEL
Middle Name:CLIFFORD
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 1:5241 PALOMA RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-2247
Mailing Address - Country:US
Mailing Address - Phone:209-718-3453
Mailing Address - Fax:
Practice Address - Street 1:5241 PALOMA RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-2247
Practice Address - Country:US
Practice Address - Phone:209-718-3453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic