Provider Demographics
NPI:1053455311
Name:HENRY, BRUCE A (MD,PA)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:HENRY
Suffix:
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 SE GREEN OAKS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-0953
Mailing Address - Country:US
Mailing Address - Phone:817-466-7412
Mailing Address - Fax:817-466-7493
Practice Address - Street 1:2001 SE GREEN OAKS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-0953
Practice Address - Country:US
Practice Address - Phone:817-466-7412
Practice Address - Fax:817-466-7493
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine