Provider Demographics
NPI:1902867013
Name:BETHEA, HENRY L (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:L
Last Name:BETHEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 HOLLYMEAD DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-5121
Mailing Address - Country:US
Mailing Address - Phone:281-363-0848
Mailing Address - Fax:
Practice Address - Street 1:17207 KUYKENDAHL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8423
Practice Address - Country:US
Practice Address - Phone:832-698-5320
Practice Address - Fax:832-698-5321
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7698174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC13434Medicare UPIN