Healthcare Provider Details

I. General information

NPI: 1114038577
Provider Name (Legal Business Name): LIONEL ANTHONY HENRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 N PLAZA DR
TALLAHASSEE FL
32308-5323
US

IV. Provider business mailing address

1638 N PLAZA DR
TALLAHASSEE FL
32308-5323
US

V. Phone/Fax

Practice location:
  • Phone: 850-878-5147
  • Fax: 850-942-9844
Mailing address:
  • Phone: 850-878-5147
  • Fax: 850-942-9844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME 39184
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: