MEDICARE: DR. JOSE G HENAO DPM

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	213E00000X	Podiatrist	1613P	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	62JN	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1487743258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE G HENAO DPM

Provider Business Mailing Address
First Line	:	PO BOX 3536
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78523-3536
Country	:	US
Telephone Number	:	956-541-4849
Fax Number	:	956-982-1629

Provider Business Practice Location Address
First Line	:	5460 PAREDES LINE RD
Second Line	:	STE 209
City	:	BROWNSVILLE
State	:	TX
Zip	:	78526-9741
Country	:	US
Telephone Number	:	956-541-4849
Fax Number	:	956-982-1629

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	04/21/2017

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Directions to “ DR. JOSE G HENAO DPM” Practice Location

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