Provider Demographics
NPI:1265708515
Name:HENRY, DAVID PATRICK SR
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PATRICK
Last Name:HENRY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21475
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-1475
Mailing Address - Country:US
Mailing Address - Phone:501-993-5103
Mailing Address - Fax:501-227-4545
Practice Address - Street 1:47 VALLEY ESTATES DR
Practice Address - Street 2:72212
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4412
Practice Address - Country:US
Practice Address - Phone:501-993-5103
Practice Address - Fax:501-227-4545
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No171WH0202XOther Service ProvidersContractorHome Modifications