Provider Demographics
NPI:1023097946
Name:HENRY, PHILIP ROGER (DO)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ROGER
Last Name:HENRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 E ROWAN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207
Mailing Address - Country:US
Mailing Address - Phone:509-483-3155
Mailing Address - Fax:509-483-3270
Practice Address - Street 1:42 E ROWAN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207
Practice Address - Country:US
Practice Address - Phone:509-483-3155
Practice Address - Fax:509-483-3270
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0P0001500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0160793OtherL & I
WA1116060Medicaid
G30327Medicare UPIN
WAGAB29364Medicare PIN