Provider Demographics
NPI:1184810392
Name:HENRY, JOE B JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:B
Last Name:HENRY
Suffix:JR
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 1:3995 STERLINGTON RD.
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203
Mailing Address - Country:US
Mailing Address - Phone:318-329-9447
Mailing Address - Fax:318-329-9429
Practice Address - Street 1:3995 STERLINGTON RD.
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203
Practice Address - Country:US
Practice Address - Phone:318-329-9447
Practice Address - Fax:318-329-9429
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10028374207Q00000X
LA203650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10028374OtherBASIC PERMIT