Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | E4400 | TX |
N | 207VX0000X | Obstetrician | E4400 | TX |
NPI | 1457311623 |
---|---|
Provider Name | Dr. Robert Henry III |
First Address | Fort Worth, TX 76110-4415 |
Second Address | Fort Worth, TX 76110-4415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 19/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
033042501 | (05) | TX |
UD66548 | (02) | TX |