Provider Demographics
NPI:1326087925
Name:HENRY, CHRISTOPHER PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PATRICK
Last Name:HENRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:1717 S J ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4933
Practice Address - Country:US
Practice Address - Phone:253-426-4101
Practice Address - Fax:253-426-6250
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25357207P00000X
CA54616207P00000X
WAMD00040182207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2165HEOtherBSWA ST JOE MEDICAL
WA1186HEOtherBSWA ST CLARE
WA0172910OtherLIWA ST JOE MEDICAL
WA0172911OtherLIWA ST CLARE
WA8227589Medicaid
WAGAB24158Medicare PIN
WA2165HEOtherBSWA ST JOE MEDICAL
WAP00222310Medicare PIN
WA1186HEOtherBSWA ST CLARE