Healthcare Provider Details

I. General information

NPI: 1356394415
Provider Name (Legal Business Name): HENRY FOOKS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 COLUMBUS RD
ATHENS OH
45701-1334
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 740-589-3100
  • Fax: 740-589-3132
Mailing address:
  • Phone: 740-446-5890
  • Fax: 740-446-5532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35-08-7648
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: