Provider Demographics
NPI:1851666523
Name:ANDREW D. HENRY M.D., P.A.
Entity Type:Organization
Organization Name:ANDREW D. HENRY M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-676-0234
Mailing Address - Street 1:9270 BAY PLAZA BLVD
Mailing Address - Street 2:640
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4499
Mailing Address - Country:US
Mailing Address - Phone:813-676-0234
Mailing Address - Fax:813-676-0237
Practice Address - Street 1:9270 BAY PLAZA BLVD
Practice Address - Street 2:640
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4499
Practice Address - Country:US
Practice Address - Phone:813-676-0234
Practice Address - Fax:813-676-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 79549174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty