Healthcare Provider Details

I. General information

NPI: 1104243468
Provider Name (Legal Business Name): HENRY DOLLAHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6205 LOCKE AVE
FORT WORTH TX
76116-4636
US

IV. Provider business mailing address

6451 BRENTWOOD STAIR RD STE 100
FORT WORTH TX
76112-3200
US

V. Phone/Fax

Practice location:
  • Phone: 817-946-2051
  • Fax: 972-249-0206
Mailing address:
  • Phone: 972-249-0200
  • Fax: 972-249-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberR2846
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR2846
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: