Provider Demographics
NPI:1679905707
Name:HENRY, STEPHEN NOEL (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:NOEL
Last Name:HENRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:NOEL
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:13707 SW 152ND STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1420
Mailing Address - Country:US
Mailing Address - Phone:305-585-9200
Mailing Address - Fax:
Practice Address - Street 1:13707 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1106
Practice Address - Country:US
Practice Address - Phone:305-585-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14839207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine