Healthcare Provider Details

I. General information

NPI: 1659433795
Provider Name (Legal Business Name): JOHN HENRIQUES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W COURT ST
PASCO WA
99301-3737
US

IV. Provider business mailing address

515 W COURT ST
PASCO WA
99301-3737
US

V. Phone/Fax

Practice location:
  • Phone: 509-547-2204
  • Fax: 509-545-3960
Mailing address:
  • Phone: 509-547-2204
  • Fax: 509-545-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00011817
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: