Provider Demographics
NPI:1376864546
Name:GENTLES, ROSELYNN A (MD)
Entity type:Individual
Prefix:DR
First Name:ROSELYNN
Middle Name:A
Last Name:GENTLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S CLARK ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2328
Mailing Address - Country:US
Mailing Address - Phone:406-723-2500
Mailing Address - Fax:406-723-2483
Practice Address - Street 1:817 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-1316
Practice Address - Country:US
Practice Address - Phone:509-548-5815
Practice Address - Fax:509-548-2510
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4270207P00000X
MT25490207P00000X
WAMD60632019207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2087329Medicaid
WA358470OtherDEPARTMENT OF LABOR & INDUSTRIES