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General NPI Number Information
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NPI Number | 1447261201
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Entity Type | Individual
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Provider Name | KEITH ALLEN HENRY M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | 7950 W JEFFERSON BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46804-4140
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Country | US
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Telephone | 260-435-2772
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 VIRGINIA WAY STE 300
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City | BRENTWOOD
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State | TN
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Zip | 37027-7542
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Country | US
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Telephone | 615-221-4400
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Fax |
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 51606
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 54071
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MD2020-0138
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 30299
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 01092894A
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License Number State | IN
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