Provider Demographics
NPI:1457311623
Name:HENRY, ROBERT III (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:HENRY
Suffix:III
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 1:920 E BERRY ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-4415
Mailing Address - Country:US
Mailing Address - Phone:817-921-6081
Mailing Address - Fax:817-923-7091
Practice Address - Street 1:920 E BERRY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-4415
Practice Address - Country:US
Practice Address - Phone:817-921-6081
Practice Address - Fax:817-923-7091
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4400207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033042501Medicaid
TX033042501Medicaid
TX00ER94Medicare ID - Type Unspecified
TX033042501Medicaid