Provider Demographics
NPI:1245201995
Name:HENRY, CHARLES S (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:HENRY
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 SOUTHWEST FWY STE 304
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1813
Mailing Address - Country:US
Mailing Address - Phone:713-270-4545
Mailing Address - Fax:713-270-9197
Practice Address - Street 1:7777 SOUTHWEST FWY STE 304
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1813
Practice Address - Country:US
Practice Address - Phone:713-270-4545
Practice Address - Fax:713-270-9197
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2315207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166236301Medicaid
TXI09425Medicare UPIN
TX166236301Medicaid