Provider Demographics
NPI:1740266303
Name:GENTRY, RONNIE (MD)
Entity type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:
Last Name:GENTRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 1950
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-441-4280
Mailing Address - Fax:713-790-2860
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 1950
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-441-4280
Practice Address - Fax:713-790-2860
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4147207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CN638OtherBLUE CROSS BLUE SHIELD
TX8EF364OtherBLUE CROSS BLUE SHIELD
TX8V4451OtherBCBS
P00333634OtherRR MEDICARE
TXP00892884OtherRR MEDICARE
TX8EF364OtherBLUE CROSS BLUE SHIELD
TXTXB115233Medicare PIN
8G5837Medicare PIN