Individual
DR. MARK A HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 TRADEPARK DR, STE A, SOMERSET, KY 42503-3454
(606) 679-7778
(606) 451-1814
Mailing address
120 TRADEPARK DR, STE A, SOMERSET, KY 42503-3454
(606) 679-7778
(606) 451-1814
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
27260
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000071743
BCBS
—
01
—
1520956
UMWA
—
01
—
180028760
RAILROAD MEDICARE
—
01
—
3061400
BLUE CROSS
TN
05
—
4020794
—
TN
05
—
64272602
—
KY
Enumeration date
12/01/2005
Last updated
04/04/2013
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