Provider Demographics
NPI:1245282078
Name:GENTRY, DANIEL EARL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:EARL
Last Name:GENTRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:STE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:201 W HOLLY HILL RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-5738
Practice Address - Country:US
Practice Address - Phone:336-475-9164
Practice Address - Fax:336-475-6619
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC23538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8935074Medicaid
NC8935074Medicaid
NCC68727Medicare UPIN
NC202125CMedicare PIN