MEDICARE: BRUCE A HENRY M.D.,P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	H2454	TX

General Provider Information

NPI Number	:	1053455311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE A HENRY M.D.,P.A.

Provider Business Mailing Address
First Line	:	2001 SE GREEN OAKS BLVD STE 100
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-0953
Country	:	US
Telephone Number	:	817-466-7412
Fax Number	:	817-466-7493

Provider Business Practice Location Address
First Line	:	2001 SE GREEN OAKS BLVD STE 100
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-0953
Country	:	US
Telephone Number	:	817-466-7412
Fax Number	:	817-466-7493

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	01/20/2011

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