Healthcare Provider Details

I. General information

NPI: 1770560484
Provider Name (Legal Business Name): HENRY L. DANIS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2544 COURT DR STE H
GASTONIA NC
28054-3450
US

IV. Provider business mailing address

2544 COURT DR STE H
GASTONIA NC
28054-3450
US

V. Phone/Fax

Practice location:
  • Phone: 704-854-9990
  • Fax: 704-854-9045
Mailing address:
  • Phone: 704-854-9990
  • Fax: 704-854-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number200800917
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: