Provider Demographics
NPI:1326483009
Name:CHEN, HENRY
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 NURSING HOME DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-3839
Mailing Address - Country:US
Mailing Address - Phone:863-993-2966
Mailing Address - Fax:863-494-5491
Practice Address - Street 1:701 MANATEE AVE W STE 101
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8624
Practice Address - Country:US
Practice Address - Phone:941-748-3065
Practice Address - Fax:941-748-8620
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO3321207R00000X
FLOS13046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4692270OtherAETNA
FL90VSWOtherBCBS
FL016918900Medicaid
FL90VSWOtherBCBS