Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 105057 | MO |
NPI | 1003818592 |
---|---|
Provider Name | Dr. Robert L Henley JR. |
First Address | Kansas City, MO 64141-4965 |
Second Address | Blue Springs, MO 64014-2518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 18/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206953911 | (05) | MO |
20702041 | BCBS MO (01) | MO |
E68339 | (02) |