Healthcare Provider Details

I. General information

NPI: 1780681734
Provider Name (Legal Business Name): BARRY J HENRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 OAK PARK BLVD FL 3
LAKE CHARLES LA
70601-8990
US

IV. Provider business mailing address

PO BOX 122165 DEPT 2165
DALLAS TX
75312-0001
US

V. Phone/Fax

Practice location:
  • Phone: 337-494-4900
  • Fax: 337-494-4947
Mailing address:
  • Phone: 337-494-2921
  • Fax: 337-494-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberK1214
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number13483R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: