Provider Demographics
NPI:1750477683
Name:GENTRY, JERRY LEE II (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:LEE
Last Name:GENTRY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5514 ATASCOCITA RD
Mailing Address - Street 2:SUITE 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:832-644-5597
Practice Address - Street 1:5514 ATASCOCITA RD
Practice Address - Street 2:SUITE 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:832-644-5597
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN8918208VP0014X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9805166OtherCIGNA PIN
MS00118334Medicaid
MS9805166OtherCIGNA PIN
MS080004183Medicare PIN
MS00118334Medicaid