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Individual

DR. ROBERT A. HENRY JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
2817 NEW PINERY ROAD, PORTAGE, WI 53901-9257
(608) 742-4131
Mailing address
2817 NEW PINERY ROAD, PORTAGE, WI 53901-9257
(608) 742-4131

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
65243-21
WI
207Q00000X
Family Medicine Physician
H1102
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
080161793
RR/MEDICARE
TX
01
1010845-01
CSHCN
TX
05
1010845-02
TX
01
807629
BLUE SHIELD
TX
Enumeration date
03/27/2006
Last updated
03/24/2016
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