Provider Demographics
NPI:1598984742
Name:HENRY, WILLIAM TAYLOR JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TAYLOR
Last Name:HENRY
Suffix:JR
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 1:9601 BAPTIST HEALTH DR STE 1100
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6333
Mailing Address - Country:US
Mailing Address - Phone:501-227-5240
Mailing Address - Fax:501-227-9151
Practice Address - Street 1:9601 BAPTIST HEALTH DR STE 1100
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6333
Practice Address - Country:US
Practice Address - Phone:501-227-5240
Practice Address - Fax:501-227-9151
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL92422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167483004Medicaid
TX8J6396Medicare UPIN