Provider Demographics
NPI:1205836061
Name:HENRY, THOMAS SEYMOUR (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SEYMOUR
Last Name:HENRY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N BEARD ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-6715
Mailing Address - Country:US
Mailing Address - Phone:405-273-0500
Mailing Address - Fax:405-273-0500
Practice Address - Street 1:ROUTE 2 BOX 247
Practice Address - Street 2:BLACK HAWK HEALTH CENTER
Practice Address - City:STROUD
Practice Address - State:OK
Practice Address - Zip Code:74079
Practice Address - Country:US
Practice Address - Phone:918-968-9531
Practice Address - Fax:918-968-1532
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK99207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKT40749Medicare UPIN
OK8HZ175Medicare ID - Type UnspecifiedPART B