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	:	1982936555
Entity Type Code	:	Organization
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	:	817-547-9526
Fax Number	:

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	:	817-861-1055
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ PROVIDER
Name	:	DR. BRUCE ALLEN HENRY
Credential	:	M.D., P.A.
Telephone Number	:	817-861-1055

Provider Enumeration Date	:	02/08/2010
Last Update Date	:	02/10/2010

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