Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 7241 | NV |
Y | 207KA0200X | Allergist | M6017 | ID |
NPI | 1013904622 |
---|---|
Provider Name | Richard Eugene Henry |
First Address | Twin Falls, ID 83301-3366 |
Second Address | Twin Falls, ID 83301-3366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 20/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002736100 | (05) | ID |
002736101 | (05) | ID |
002736102 | (05) | ID |
F28068 | (02) | ID |