Provider Demographics
NPI:1144218884
Name:HENRY, CLARA H (MD)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:H
Last Name:HENRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2548 LILLIAN MILLER PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-7212
Mailing Address - Country:US
Mailing Address - Phone:940-387-7565
Mailing Address - Fax:940-566-0574
Practice Address - Street 1:2548 LILLIAN MILLER PKWY
Practice Address - Street 2:STE 100
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-7212
Practice Address - Country:US
Practice Address - Phone:940-387-7565
Practice Address - Fax:940-566-0574
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF7778207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00MB67OtherBLUE CROSS IDENTIFIER
TX00MB67OtherBLUE CROSS IDENTIFIER