Healthcare Provider Details

I. General information

NPI: 1679905707
Provider Name (Legal Business Name): STEPHEN NOEL HENRY D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STEPHEN NOEL HENRY D.O

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13707 SW 152ND ST
MIAMI FL
33177-1106
US

IV. Provider business mailing address

13707 SW 152ND STREET
MIAMI FL
33177-1420
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-9200
  • Fax:
Mailing address:
  • Phone: 305-585-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS14839
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS14839
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: