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Individual

DR. KEITH ALLEN HENRY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 435-2772
Mailing address
5301 VIRGINIA WAY STE 300, BRENTWOOD, TN 37027-7542
(615) 221-4400

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01092894A
IN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
30299
WI
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
51606
TX
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
54071
KY
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
MD2020-0138
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
32093700
WI
05
7100668960
KY
Enumeration date
08/10/2006
Last updated
04/02/2024
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