Provider Demographics
NPI:1598863896
Name:GENTRY, CHRISTINE (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:GENTRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:MCGINNISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:806 SW COLLINS AVE
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608-5532
Practice Address - Country:US
Practice Address - Phone:417-269-2293
Practice Address - Fax:417-269-2296
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO248515215Medicaid
000665119Medicare PIN
MO248515215Medicaid
001013575Medicare PIN
080099313Medicare PIN
E63477Medicare UPIN