Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | CH2416 | MA |
Y | 213ER0200X | Radiology | CH2416 | MA |
NPI | 1033208244 |
---|---|
Provider Name | John Raymond Henry |
First Address | South Easton, MA 02375-1200 |
Second Address | South Easton, MA 02375-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U78594 | (02) | MA |