Provider Demographics
NPI:1760500102
Name:HENRY, GREGORY L (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:HENRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:6500 HOSPITAL DR
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401
Mailing Address - Country:US
Mailing Address - Phone:573-629-3330
Mailing Address - Fax:573-629-3334
Practice Address - Street 1:6500 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401
Practice Address - Country:US
Practice Address - Phone:573-629-3330
Practice Address - Fax:573-629-3334
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2016-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MODO48D79207X00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery