Individual
STEPHEN DOUGLAS HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2319 E WASHINGTON BLVD, SUITE 2, PASADENA, CA 91104-1945
(626) 797-8800
(626) 797-8575
Mailing address
2319 E WASHINGTON BLVD, SUITE 2, PASADENA, CA 91104-1945
(626) 797-8800
(626) 797-8079
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
C37981
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
953652123
FEDERAL TAX ID
—
01
—
C37981
STATE LICENSE
CA
Enumeration date
06/28/2006
Last updated
05/18/2011
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