Provider Demographics
NPI:1518033190
Name:GENTRY, MARVIN L (ND)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:L
Last Name:GENTRY
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4700
Mailing Address - Country:US
Mailing Address - Phone:206-708-9888
Mailing Address - Fax:866-740-9424
Practice Address - Street 1:2607 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 1A
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4700
Practice Address - Country:US
Practice Address - Phone:206-708-9888
Practice Address - Fax:866-740-9424
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001200175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath