Provider Demographics
NPI:1164961694
Name:HENRY, DOWIL (EMT)
Entity Type:Individual
Prefix:MR
First Name:DOWIL
Middle Name:
Last Name:HENRY
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:DOWIL
Other - Middle Name:
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EMT
Mailing Address - Street 1:9628 NE 2ND AVE
Mailing Address - Street 2:SUITE#B3
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2767
Mailing Address - Country:US
Mailing Address - Phone:305-907-7554
Mailing Address - Fax:305-907-7554
Practice Address - Street 1:9628 NE 2ND AVE
Practice Address - Street 2:SUITE#B3
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2767
Practice Address - Country:US
Practice Address - Phone:305-907-7554
Practice Address - Fax:305-907-7554
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL523668146N00000X
FLRPT32406405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No405300000XOther Service ProvidersPrevention Professional