Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO1000009 | DC |
NPI | 1578504460 |
---|---|
Provider Name | Dr. Victor Elton Henry |
First Address | Bowie, MD 20721-7206 |
Second Address | Washington, DC 20016-1851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T78572 | (02) | DC |