Provider Demographics
NPI:1508862905
Name:HENRY, GERARD DAYLE (MD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:DAYLE
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 1:2449 HOSPITAL DR
Mailing Address - Street 2:STE 280
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-1900
Mailing Address - Country:US
Mailing Address - Phone:318-212-7850
Mailing Address - Fax:318-841-4008
Practice Address - Street 1:2449 HOSPITAL DR
Practice Address - Street 2:STE 280
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-1900
Practice Address - Country:US
Practice Address - Phone:318-212-7850
Practice Address - Fax:318-841-4008
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15041R208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00144298OtherRAILROAD MEDICARE
LA1179876Medicaid
LAP00144298OtherRAILROAD MEDICARE
LA1179876Medicaid