Individual
DR. JACK HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4004 82ND ST, LUBBOCK, TX 79423-1900
(806) 722-3100
Mailing address
4004 82ND ST, LUBBOCK, TX 79423-1900
(806) 722-3100
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
D1880
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
048641703
—
TX
05
—
099944301
—
TX
Enumeration date
02/07/2006
Last updated
02/28/2012
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