Provider Demographics
NPI:1609869882
Name:HENY, JOSEPH SAMARA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SAMARA
Last Name:HENY
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 1:903 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-5136
Mailing Address - Country:US
Mailing Address - Phone:210-432-7801
Mailing Address - Fax:210-342-2221
Practice Address - Street 1:903 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5136
Practice Address - Country:US
Practice Address - Phone:210-432-7801
Practice Address - Fax:210-342-2221
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC6986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC16832Medicare UPIN
TX009507Medicare ID - Type Unspecified