Healthcare Provider Details

I. General information

NPI: 1285861120
Provider Name (Legal Business Name): DAVID EDWARD HENRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 09/30/2022
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1753 W RIDGEWAY AVE STE 107
WATERLOO IA
50701-4588
US

IV. Provider business mailing address

1634 PLYMOUTH AVE
BRONX NY
10461-4844
US

V. Phone/Fax

Practice location:
  • Phone: 319-833-5907
  • Fax:
Mailing address:
  • Phone: 808-859-0892
  • Fax: 844-804-3051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD450954
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD0000056454
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301094689
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5315041522
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD18168
License Number StateHI
# 6
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-50117
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: