Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 23002 | OK |
N | 111NI0900X | Internist | 23002 | OK |
N | 207RS0012X | Sleep Medicine | 207239 | LA |
N | 208000000X | Pediatrician | 23002 | OK |
N | 2080P0210X | Pediatric Nephrologist | 31521 | AL |
NPI | 1952359077 |
---|---|
Provider Name | Dr. Dwayne Henry |
First Address | Baton Rouge, LA 70808-4300 |
Second Address | Baton Rouge, LA 70808-4300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 25/03/2021 |