Provider Demographics
NPI:1316009947
Name:UNDERWOOD, HENRY LEON III (DO)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:LEON
Last Name:UNDERWOOD
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-0911
Mailing Address - Country:US
Mailing Address - Phone:903-455-8000
Mailing Address - Fax:903-454-3577
Practice Address - Street 1:3800 JOE RAMSEY BLVD E
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7711
Practice Address - Country:US
Practice Address - Phone:903-455-8000
Practice Address - Fax:903-454-3577
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122836304Medicaid
TX82Z501Medicare PIN
TXA67742Medicare UPIN