Individual
DOUGLAS GLENN HENRICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2450 TAMIAMI TRL, PORT CHARLOTTE, FL 33952
(941) 624-2704
(941) 627-6066
Mailing address
3434 HANCOCK BRIDGE PKWY STE 301, NORTH FORT MYERS, FL 33903-7099
(877) 856-3774
(239) 599-2612
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME0041258
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36367V
UNSPECIFIED
FL
Enumeration date
07/25/2006
Last updated
03/12/2019
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