Provider Demographics
NPI:1023077567
Name:RAROQUE, HENRY G JR (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:G
Last Name:RAROQUE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1215 KINWEST PKWY
Mailing Address - Street 2:STE 120
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063
Mailing Address - Country:US
Mailing Address - Phone:214-496-0500
Mailing Address - Fax:214-496-0922
Practice Address - Street 1:1215 KINWEST PKWY
Practice Address - Street 2:STE 120
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063
Practice Address - Country:US
Practice Address - Phone:214-496-0500
Practice Address - Fax:214-496-0922
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH67482084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF28756Medicare UPIN
TX00L58XMedicare PIN