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General NPI Number Information
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NPI Number | 1629298583
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Entity Type | Individual
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Provider Name | ROBERT CARL HENRY PA-C, MPAS
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Gender | Male
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4351 BOOTH CALLOWAY RD SUITE 101
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180-7378
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Country | US
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Telephone | 817-284-1165
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Fax | 817-284-3268
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Provider Business Mailing Address
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Address Line | 876 FOX HUNT TRL
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City | FORT WORTH
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State | TX
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Zip | 76179-2354
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Country | US
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Telephone | 682-286-0293
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA03006
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License Number State | TX
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