Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 6172 | KY |
N | 213EG0000X | General Practice | 6172 | KY |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 6172 | KY |
NPI | 1073616850 |
---|---|
Provider Name | Walter Andrew Henry |
First Address | Ft Hood, TX 76544 |
Second Address | Ft Hood, TX 76544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 21/06/2013 |