Provider Demographics
NPI:1619011988
Name:HENRY, CRAIG B (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:B
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 1:1217 FLORIDA DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2380
Mailing Address - Country:US
Mailing Address - Phone:817-375-5048
Mailing Address - Fax:817-375-5097
Practice Address - Street 1:1217 FLORIDA DR
Practice Address - Street 2:SUITE 111
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2380
Practice Address - Country:US
Practice Address - Phone:817-375-5048
Practice Address - Fax:817-375-5097
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114087304Medicaid
TX098879203Medicaid
TXC16822Medicare UPIN
TX114087304Medicaid
TX114087304Medicaid