Provider Demographics
NPI:1619283181
Name:ROBERT HENRY, III, MD, PA
Entity Type:Organization
Organization Name:ROBERT HENRY, III, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:817-921-6081
Mailing Address - Street 1:920 E BERRY ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-4415
Mailing Address - Country:US
Mailing Address - Phone:817-921-6081
Mailing Address - Fax:817-923-7091
Practice Address - Street 1:920 E BERRY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-4415
Practice Address - Country:US
Practice Address - Phone:817-921-6081
Practice Address - Fax:817-923-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4400207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty