Provider Demographics
NPI:1396008611
Name:MCHENRY, CLINT WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:CLINT
Middle Name:WILLIAM
Last Name:MCHENRY
Suffix:
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 18962
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4084
Mailing Address - Country:US
Mailing Address - Phone:800-566-5050
Mailing Address - Fax:254-755-6695
Practice Address - Street 1:2100 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-1271
Practice Address - Country:US
Practice Address - Phone:254-537-6160
Practice Address - Fax:254-755-6695
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10044616207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine