Basic Information
| Provider Information | |||||||||
| NPI: | 1952747149 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GENTRY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | HAYMAN | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 FISHER ST | ||||||||
| Address2: | |||||||||
| City: | KAFB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39564 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 FISHER ST | ||||||||
| Address2: | |||||||||
| City: | KAFB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052728437 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2013 | ||||||||
| LastUpdateDate: | 07/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 27745 | MS | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.