Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 509 | TX |
Y | 222Z00000X | Podiatrist | 509 | TX |
NPI | 1013272178 |
---|---|
Provider Name | Jason Henry |
First Address | Spring, TX 77386-2388 |
Second Address | Spring, TX 77386-2388 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2012 |
Last Update Date | 05/07/2012 |