Basic Information
Provider Information
NPI: 1003139445
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HENRY
FirstName: JOSEPH
MiddleName: PATRICK
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HENRY
OtherFirstName: JOE
OtherMiddleName: PATRICK
OtherNamePrefix: DR.
OtherNameSuffix:  
OtherCredential: M.D.
OtherLastNameType: 5
Mailing Information
Address1: DEPT 34929
Address2: P.O. BOX 39000
City: SAN FRANCISCO
State: CA
PostalCode: 941390001
CountryCode: US
TelephoneNumber: 9259522828
FaxNumber: 9259522850
Practice Location
Address1: 1220 ROSSMOOR PKWY
Address2:  
City: WALNUT CREEK
State: CA
PostalCode: 945952501
CountryCode: US
TelephoneNumber: 9259473393
FaxNumber: 9259473396
Other Information
ProviderEnumerationDate: 03/11/2010
LastUpdateDate: 06/16/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XA116018CAY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
P0145151201CARAILROAD MEDICAREOTHER


Home