Healthcare Provider Details

I. General information

NPI: 1265708515
Provider Name (Legal Business Name): MR. DAVID PATRICK HENRY SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 VALLEY ESTATES DR 72212
LITTLE ROCK AR
72212-4412
US

IV. Provider business mailing address

PO BOX 21475
LITTLE ROCK AR
72221-1475
US

V. Phone/Fax

Practice location:
  • Phone: 501-993-5103
  • Fax: 501-227-4545
Mailing address:
  • Phone: 501-993-5103
  • Fax: 501-227-4545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: