Healthcare Provider Details

I. General information

NPI: 1811925183
Provider Name (Legal Business Name): STEPHEN DOUGLAS HENRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 E WASHINGTON BLVD SUITE 2
PASADENA CA
91104-1945
US

IV. Provider business mailing address

2319 E WASHINGTON BLVD SUITE 2
PASADENA CA
91104-1945
US

V. Phone/Fax

Practice location:
  • Phone: 626-797-8800
  • Fax: 626-797-8575
Mailing address:
  • Phone: 626-797-8800
  • Fax: 626-797-8079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberC37981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: