=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982936555
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRUCE A. HENRY, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2010
-----------------------------------------------------
Last Update Date | 02/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 SE GREEN OAKS BLVD STE 100
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76018-0953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-861-1055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 SE GREEN OAKS BLVD STE 100
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76018-0953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-547-9526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ PROVIDER
-----------------------------------------------------
Name | DR. BRUCE ALLEN HENRY
-----------------------------------------------------
Credential | M.D., P.A.
-----------------------------------------------------
Telephone | 817-861-1055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | H2454
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------