Provider Demographics
NPI:1245680255
Name:RELIEF PAIN AND WELLNESS
Entity type:Organization
Organization Name:RELIEF PAIN AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:713-400-3038
Mailing Address - Street 1:5514 ATASCOCITA RD
Mailing Address - Street 2:STE 290
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2968
Mailing Address - Country:US
Mailing Address - Phone:713-400-3038
Mailing Address - Fax:832-201-9644
Practice Address - Street 1:5514 ATASCOCITA RD
Practice Address - Street 2:STE 290
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2968
Practice Address - Country:US
Practice Address - Phone:713-400-3038
Practice Address - Fax:832-201-9644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8918207R00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty