Individual
ANTHONY C HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
10215 AUBURN PARK DR, FORT WAYNE, IN 46825-2387
(260) 234-5400
(260) 234-5110
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02001404A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000091891
BLUE CROSS BLUE SHIELD
—
05
—
100329430
—
IN
01
—
P00970619
RAILROAD MEDICARE
IN
Enumeration date
11/03/2005
Last updated
01/09/2025
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