Provider Demographics
NPI:1841229812
Name:PROST, HENRY M (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:M
Last Name:PROST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7141 COLLEYVILLE 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:817-793-3422
Mailing Address - Fax:817-251-8654
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:817-793-3422
Practice Address - Fax:817-410-9963
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK8967207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8845B0OtherPTAN
TXH58953Medicare UPIN