Provider Demographics
NPI:1508205543
Name:HENRY, DERMOND CORTEZ (DO)
Entity Type:Individual
Prefix:DR
First Name:DERMOND
Middle Name:CORTEZ
Last Name:HENRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-851-1000
Mailing Address - Fax:314-851-4445
Practice Address - Street 1:12345 W BEND DR STE 300
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2255
Practice Address - Country:US
Practice Address - Phone:314-849-6000
Practice Address - Fax:314-849-1417
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2024-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2015026154207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine