Provider Demographics
NPI:1114975943
Name:DAVID, HENRY W (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:W
Last Name:DAVID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:ONE HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-6003
Practice Address - Fax:573-884-5410
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004036764207P00000X
TXP0032207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO111238OtherBLUE SHIELD/BLUE CROSS
MO207190406Medicaid
MO701436OtherHEALTHLINK
MO207190406Medicaid
MOP00249853Medicare PIN
MOP00470980Medicare PIN
MO701436OtherHEALTHLINK
MO929881878Medicare PIN