Individual
MR. DOUGLAS EDWIN HENRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1225 S GEAR AVE, STE 255, WEST BURLINGTON, IA 52655-1687
(319) 752-2725
(319) 753-1084
Mailing address
1225 S GEAR AVE, STE 255, WEST BURLINGTON, IA 52655-1687
(319) 752-2725
(319) 753-1084
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
31549
IA
207KA0200X
Allergy Physician
31549
IA
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
31549
IA
207Y00000X
Otolaryngology Physician
Primary
31549
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0151092
—
IA
01
—
58619
WELLMARK #
IA
Enumeration date
01/24/2006
Last updated
02/24/2015
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