Active NPI
Edward Michael Gentile, D.O.
- Psychiatry Physician
- Tucson, AZ
National Provider Identifier
1225118359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 2368
- Practice address
- 4575 E Broadway Blvd
Tucson, AZ 85711-3509 - Phone
- (520) 901-6816
- Fax
- (520) 901-6846
- NPI assigned
- Oct 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 2368 | AZ | Primary |
| Psychiatry Physician | 2084P0800X | OS004221-L | PA | |
| Psychiatry Physician | 2084P0800X | 701 | WV |
Addresses
Primary practice location
4575 E Broadway Blvd
Tucson, AZ 85711-3509
Mailing address
4575 E Broadway Blvd
Tucson, AZ 85711-3509
Phone (520) 901-6816
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 701 | WV | MD | Chiropractor |
| OS004221-L | PA | MD | Psychiatry Physician |
| 2368 | AZ | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225118359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4575 E BROADWAY BLVD",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857113509",
"telephone_number": "520-901-6816",
"fax_number": "520-901-6846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4575 E BROADWAY BLVD",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857113509",
"telephone_number": "520-901-6816",
"fax_number": "520-901-6846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENTILE",
"first_name": "EDWARD",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "AZ",
"license": "2368",
"primary": true
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "OS004221-L",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WV",
"license": "701",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.