Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | ME 39184 | FL |
NPI | 1114038577 |
---|---|
Provider Name | Dr. Lionel Anthony Henry |
First Address | Tallahassee, FL 32308-5323 |
Second Address | Tallahassee, FL 32308-5323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D54618 | (02) | FL |