Provider Demographics
NPI:1750446571
Name:GENTRY, LAYNE O (MD)
Entity Type:Individual
Prefix:
First Name:LAYNE
Middle Name:O
Last Name:GENTRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6624 FANNIN ST
Mailing Address - Street 2:SUITE 1450
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2312
Mailing Address - Country:US
Mailing Address - Phone:713-383-6882
Mailing Address - Fax:713-799-9917
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:SUITE 1450
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2312
Practice Address - Country:US
Practice Address - Phone:713-383-6882
Practice Address - Fax:713-799-9917
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2010-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE1588207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0004406874OtherAETNA
TX100114101Medicaid
TX440000033OtherMEDICARE RR
TX89C791OtherBLUE CROSS
TXB22931Medicare UPIN
TX440000033OtherMEDICARE RR
TX100114101Medicaid