Provider Demographics
NPI:1225099815
Name:READ, HENRY N (PA)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:N
Last Name:READ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 SW RAMSEY AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5859
Mailing Address - Country:US
Mailing Address - Phone:541-472-0603
Mailing Address - Fax:541-472-0609
Practice Address - Street 1:702 SW RAMSEY AVE STE 112
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5859
Practice Address - Country:US
Practice Address - Phone:541-472-0603
Practice Address - Fax:541-472-0609
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6775363L00000X
ORPA157583363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0209582OtherSTATE OF WASHINGTON
CA0209582OtherSTATE OF WASHINGTON
CAR20840Medicare UPIN