Provider Demographics
NPI:1689887077
Name:GENTRY, WILLIAM BYRON (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BYRON
Last Name:GENTRY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 NW 36TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2704
Mailing Address - Country:US
Mailing Address - Phone:405-942-5313
Mailing Address - Fax:405-948-0167
Practice Address - Street 1:4435 NW 36TH ST STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2704
Practice Address - Country:US
Practice Address - Phone:405-942-5313
Practice Address - Fax:405-948-0167
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKO0609Medicare ID - Type UnspecifiedEDI PROVIDER ID
OKT75165Medicare UPIN