Healthcare Provider Details

I. General information

NPI: 1710962485
Provider Name (Legal Business Name): WILLIAM WARREN HENRY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 LOCUST GROVE RD
BATESVILLE AR
72501-9014
US

IV. Provider business mailing address

2410 LOCUST GROVE RD
BATESVILLE AR
72501-9014
US

V. Phone/Fax

Practice location:
  • Phone: 870-834-4461
  • Fax: 870-251-2504
Mailing address:
  • Phone: 870-834-4461
  • Fax: 870-251-2504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC-8439
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: