Provider Demographics
NPI:1659300549
Name:HENRY M. PROST, MD PLLC
Entity Type:Organization
Organization Name:HENRY M. PROST, MD PLLC
Other - Org Name:ENDOCRINE & THYROID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PROST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-793-3422
Mailing Address - Street 1:7141 COLLYVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6240
Mailing Address - Country:US
Mailing Address - Phone:817-410-9993
Mailing Address - Fax:817-410-9963
Practice Address - Street 1:7141 COLLEYVILLE BLVD
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6240
Practice Address - Country:US
Practice Address - Phone:817-410-9993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00464TMedicare ID - Type UnspecifiedGROUP NUMBER