Provider Demographics
NPI:1598864126
Name:HENRY, LINDA (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
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:PO BOX 99213
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0213
Mailing Address - Country:US
Mailing Address - Phone:682-885-4433
Mailing Address - Fax:682-885-3939
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4095
Practice Address - Fax:682-885-7499
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2455207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137283103Medicaid
1669442042OtherGRP NPI NUMBER
TX88V503OtherBCBSTX IND PIN
TX00L42VOtherBCBSTX GRP PIN
TX132729803Medicaid
TX137345805Medicaid
TX8417407OtherCIGNA PIN
TX100912OtherSUPERIOR PIN
TX132729805Medicaid
TX413462OtherPHCS PIN
TX10028755OtherAMERIGROUP PIN
TX4586668OtherAETNA PIN
TX916974OtherUHC PIN
TX114966100OtherFIRSTCARE PIN
TX1640357OtherFIRSTHEALTH PIN
TX88V503OtherBCBSTX IND PIN
TX10028755OtherAMERIGROUP PIN
TX137283103Medicaid
TX8417407OtherCIGNA PIN