1003139445 NPI number — DR. JOSEPH PATRICK HENRY M.D.

Table of content: DR. JOSEPH PATRICK HENRY M.D. (NPI 1003139445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003139445 NPI number — DR. JOSEPH PATRICK HENRY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENRY
Provider First Name:
JOSEPH
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENRY
Provider Other First Name:
JOE
Provider Other Middle Name:
PATRICK
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1003139445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2645 SNYDER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-4445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-409-6511
Provider Business Mailing Address Fax Number:
719-941-8247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2645 SNYDER CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94598-4445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-409-6511
Provider Business Practice Location Address Fax Number:
719-941-8247
Provider Enumeration Date:
03/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A116018 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P01451512 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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