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General NPI Number Information
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NPI Number | 1316009947
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Entity Type | Individual
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Provider Name | HENRY LEON UNDERWOOD III D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 3800 JOE RAMSEY BLVD E SUITE A
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City | GREENVILLE
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State | TX
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Zip | 75401-7711
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Country | US
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Telephone | 903-455-8000
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Fax | 903-454-3577
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Provider Business Mailing Address
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Address Line | PO BOX 911
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City | GREENVILLE
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State | TX
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Zip | 75403-0911
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Country | US
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Telephone | 903-455-8000
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Fax | 903-454-3577
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G2871
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License Number State | TX
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