Provider Demographics
NPI:1194892141
Name:HENRY, ANDREW DAVE (MD)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:DAVE
Last Name:HENRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9260 BAY PLAZA BOULEVARD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619
Mailing Address - Country:US
Mailing Address - Phone:813-676-0234
Mailing Address - Fax:813-676-0237
Practice Address - Street 1:9260 BAY PLAZA BLVD
Practice Address - Street 2:SUITE 502
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4458
Practice Address - Country:US
Practice Address - Phone:813-676-0234
Practice Address - Fax:813-676-0237
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2013-12-18
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Provider Licenses
StateLicense IDTaxonomies
FL79549207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2581760DMedicaid
FL2581760DMedicaid
H13359Medicare UPIN