Provider Demographics
NPI:1295755841
Name:HENRY, MAX ALAN (MD)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:ALAN
Last Name:HENRY
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 1:1930 DOCTORS PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-2219
Mailing Address - Country:US
Mailing Address - Phone:812-372-4463
Mailing Address - Fax:812-372-2802
Practice Address - Street 1:1930 DOCTORS PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2219
Practice Address - Country:US
Practice Address - Phone:812-372-4463
Practice Address - Fax:812-372-2802
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030454207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100052270Medicaid
IN200823550AMedicaid
IN200823550BMedicaid
ININ1376Medicare PIN
IN200823550AMedicaid
IN200823550BMedicaid
IN0235330002Medicare NSC
IN200823550BMedicaid
IN252470Medicare PIN