Provider Demographics
NPI:1205356847
Name:DELOACH, HENRY II
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:DELOACH
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3667 NW 94TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6460
Mailing Address - Country:US
Mailing Address - Phone:754-702-7222
Mailing Address - Fax:
Practice Address - Street 1:3667 NW 94TH AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6460
Practice Address - Country:US
Practice Address - Phone:754-702-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD426390762180347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle