MEDICARE: JOHN C. HENRY, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	83-218	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881845170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN C. HENRY, M.D., P.A.

Provider Business Mailing Address
First Line	:	207 N UNION AVE
Second Line	:	SUITE C
City	:	ROSWELL
State	:	NM
Zip	:	88201-3068
Country	:	US
Telephone Number	:	575-624-2330
Fax Number	:	575-622-9133

Provider Business Practice Location Address
First Line	:	207 N UNION AVE
Second Line	:	SUITE C
City	:	ROSWELL
State	:	NM
Zip	:	88201-3068
Country	:	US
Telephone Number	:	575-624-2330
Fax Number	:	575-622-9133

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. GLENDA F HENRY
Credential	:
Telephone Number	:	575-624-2330

Provider Enumeration Date	:	10/05/2008
Last Update Date	:	10/05/2008

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Directions to “JOHN C. HENRY, M.D., P.A. ” Practice Location

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