Healthcare Provider Details

I. General information

NPI: 1619919008
Provider Name (Legal Business Name): HENRY GELENDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10740 N CENTRAL EXPY SUITE 350
DALLAS TX
75231-2161
US

IV. Provider business mailing address

PO BOX 730486
DALLAS TX
75373-0486
US

V. Phone/Fax

Practice location:
  • Phone: 214-692-0146
  • Fax: 214-692-1698
Mailing address:
  • Phone: 214-692-0146
  • Fax: 214-692-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG6296
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: