Basic Information
| Provider Information | |||||||||
| NPI: | 1730533563 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENTIANA BAKAJ PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 48 POST OAK RUN | ||||||||
| Address2: | |||||||||
| City: | INEZ | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779683749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3612129850 | ||||||||
| FaxNumber: | 3615764219 | ||||||||
| Practice Location | |||||||||
| Address1: | 48 POST OAK RUN | ||||||||
| Address2: | |||||||||
| City: | INEZ | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779683749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3612129850 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2016 | ||||||||
| LastUpdateDate: | 04/18/2016 | ||||||||
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| AuthorizedOfficialLastName: | BAKAJ | ||||||||
| AuthorizedOfficialFirstName: | GENTIANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3612129850 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | P5157 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.