Provider Demographics
NPI:1790409654
Name:LONDON, HENRY W JR
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:W
Last Name:LONDON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6835 CHERRYDALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-5132
Mailing Address - Country:US
Mailing Address - Phone:281-808-3605
Mailing Address - Fax:
Practice Address - Street 1:6835 CHERRYDALE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-5132
Practice Address - Country:US
Practice Address - Phone:281-808-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09631726172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver